|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,114.56
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$3,663.60
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$3,663.60
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$630.38
|
| 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 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: 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 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 L7209
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965152
|
|
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 28FR VENOUS L7209
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965152
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,114.56
|
| 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 29/37 2-STAGE 91229C
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2965299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.16 |
| Max. Negotiated Rate |
$2,588.00 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$181.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.56
|
| 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: Dean Health DHI/DHP/ASO |
$362.06
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.25
|
| 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 |
$420.55
|
| Rate for Payer: Quartz Medicare Advantage |
$388.20
|
| Rate for Payer: The Alliance Commercial |
$2,588.00
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
CANNULA 29/37 2-STAGE 91229C
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2965299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| 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 29FR FEMORAL VENOUS 96370-029
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
2965359
|
|
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 29FR FEMORAL VENOUS 96370-029
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
2965359
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,663.60
|
| 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 2-STAGE VENOUS 32/40FR 91263C
|
Facility
|
IP
|
$772.00
|
|
| Hospital Charge Code |
2965342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.28 |
| Max. Negotiated Rate |
$710.24 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$463.20
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
CANNULA 2-STAGE VENOUS 32/40FR 91263C
|
Facility
|
OP
|
$772.00
|
|
| Hospital Charge Code |
2965342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.16 |
| Max. Negotiated Rate |
$3,088.00 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Aetna Managed Medicare |
$216.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$501.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$386.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$370.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.01
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.00
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$501.80
|
| Rate for Payer: Quartz Medicare Advantage |
$463.20
|
| Rate for Payer: The Alliance Commercial |
$3,088.00
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
CANNULA 30 FR MALLEABLE VENOUS 68130
|
Facility
|
IP
|
$733.00
|
|
| Hospital Charge Code |
4307168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.17 |
| Max. Negotiated Rate |
$674.36 |
| Rate for Payer: Aetna Commercial |
$659.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$630.38
|
| 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 30 FR MALLEABLE VENOUS 68130
|
Facility
|
OP
|
$733.00
|
|
| Hospital Charge Code |
4307168
|
|
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 30FR VENOUS 007210****OBSOLETE 5/2/14
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965153
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,114.56
|
| 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 30FR VENOUS 007210****OBSOLETE 5/2/14
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965153
|
|
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
|
|
