|
CANN.SCREW 6.5 X 115MM #121643
|
Facility
|
OP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANN.SCREW 6.5 X 115MM #121643
|
Facility
|
IP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANN.SCREW 6.5 X 120MM #121644
|
Facility
|
OP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANN.SCREW 6.5 X 120MM #121644
|
Facility
|
IP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANNULA 02 NASAL 1867
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
CANNULA 02 NASAL 1867
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
CANNULA 12FR CORONARY 30012
|
Facility
|
OP
|
$558.00
|
|
| Hospital Charge Code |
2965774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Aetna Managed Medicare |
$156.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$279.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.26
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$362.70
|
| Rate for Payer: Quartz Medicare Advantage |
$334.80
|
| Rate for Payer: The Alliance Commercial |
$2,232.00
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
CANNULA 12FR CORONARY 30012
|
Facility
|
IP
|
$558.00
|
|
| Hospital Charge Code |
2965774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$513.36 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$334.80
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
CANNULA 13FR RETROGRADE 94113T
|
Facility
|
IP
|
$1,184.00
|
|
| Hospital Charge Code |
2965372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$1,089.28 |
| Rate for Payer: Aetna Commercial |
$1,065.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,018.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.52
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,089.28
|
| Rate for Payer: Health EOS Commercial |
$1,053.76
|
| Rate for Payer: HFN Commercial |
$1,089.28
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: NAPHCARE Commercial |
$710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.28
|
| Rate for Payer: Quartz Beloit One Network |
$580.16
|
| Rate for Payer: Quartz Commercial |
$710.40
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
CANNULA 13FR RETROGRADE 94113T
|
Facility
|
OP
|
$1,184.00
|
|
| Hospital Charge Code |
2965372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna Commercial |
$1,065.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,018.24
|
| Rate for Payer: Aetna Managed Medicare |
$331.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$592.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.52
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,089.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.57
|
| Rate for Payer: Health EOS Commercial |
$1,053.76
|
| Rate for Payer: HFN Commercial |
$1,089.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$888.00
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: NAPHCARE Commercial |
$710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.28
|
| Rate for Payer: Quartz Beloit One Network |
$580.16
|
| Rate for Payer: Quartz Commercial |
$769.60
|
| Rate for Payer: Quartz Medicare Advantage |
$710.40
|
| Rate for Payer: The Alliance Commercial |
$4,736.00
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
CANNULA 15FR RETROGRADE 94115T
|
Facility
|
OP
|
$1,535.00
|
|
| Hospital Charge Code |
2965341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.80 |
| Max. Negotiated Rate |
$6,140.00 |
| Rate for Payer: Aetna Commercial |
$1,381.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.10
|
| Rate for Payer: Aetna Managed Medicare |
$429.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$997.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$767.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$736.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$813.55
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$1,412.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$858.99
|
| Rate for Payer: Health EOS Commercial |
$1,366.15
|
| Rate for Payer: HFN Commercial |
$1,412.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,151.25
|
| Rate for Payer: Multiplan Commercial |
$1,228.00
|
| Rate for Payer: NAPHCARE Commercial |
$921.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,412.20
|
| Rate for Payer: Quartz Beloit One Network |
$752.15
|
| Rate for Payer: Quartz Commercial |
$997.75
|
| Rate for Payer: Quartz Medicare Advantage |
$921.00
|
| Rate for Payer: The Alliance Commercial |
$6,140.00
|
| Rate for Payer: WEA Trust Commercial |
$844.25
|
| Rate for Payer: WPS Commercial |
$1,136.97
|
|
|
CANNULA 15FR RETROGRADE 94115T
|
Facility
|
IP
|
$1,535.00
|
|
| Hospital Charge Code |
2965341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.15 |
| Max. Negotiated Rate |
$1,412.20 |
| Rate for Payer: Aetna Commercial |
$1,381.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$813.55
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$1,412.20
|
| Rate for Payer: Health EOS Commercial |
$1,366.15
|
| Rate for Payer: HFN Commercial |
$1,412.20
|
| Rate for Payer: Multiplan Commercial |
$1,228.00
|
| Rate for Payer: NAPHCARE Commercial |
$921.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,412.20
|
| Rate for Payer: Quartz Beloit One Network |
$752.15
|
| Rate for Payer: Quartz Commercial |
$921.00
|
| Rate for Payer: WEA Trust Commercial |
$844.25
|
| Rate for Payer: WPS Commercial |
$1,136.97
|
|
|
CANNULA 17FR FEMORAL ARTERIAL 96530-117
|
Facility
|
IP
|
$3,278.00
|
|
| Hospital Charge Code |
2965355
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| 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 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$4,272.48
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| 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 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
|
|
