|
CANNULA 17FR FEMORAL ARTERIAL 96530-117
|
Facility
|
IP
|
$3,278.00
|
|
| Hospital Charge Code |
2965355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,670.47 |
| Max. Negotiated Rate |
$3,136.39 |
| Rate for Payer: Aetna Commercial |
$3,068.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,931.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.83
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,136.39
|
| Rate for Payer: Health EOS Commercial |
$3,034.12
|
| Rate for Payer: HFN Commercial |
$3,136.39
|
| Rate for Payer: Multiplan Commercial |
$2,727.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,136.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.47
|
| Rate for Payer: Quartz Commercial |
$2,045.47
|
| Rate for Payer: WEA Trust Commercial |
$1,875.02
|
| Rate for Payer: WPS Commercial |
$2,525.04
|
|
|
CANNULA 17FR FEMORAL ARTERIAL 96530-117
|
Facility
|
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.55 |
| Max. Negotiated Rate |
$3,136.39 |
| Rate for Payer: Aetna Commercial |
$3,068.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,931.84
|
| Rate for Payer: Aetna Managed Medicare |
$954.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,215.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,704.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,636.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.83
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,136.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,907.80
|
| Rate for Payer: Health EOS Commercial |
$3,034.12
|
| Rate for Payer: HFN Commercial |
$3,136.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,556.84
|
| Rate for Payer: Multiplan Commercial |
$2,727.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,045.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,136.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.47
|
| Rate for Payer: Quartz Commercial |
$2,215.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,045.47
|
| Rate for Payer: The Alliance Commercial |
$1,704.56
|
| Rate for Payer: WEA Trust Commercial |
$1,875.02
|
| Rate for Payer: WPS Commercial |
$2,525.04
|
|
|
CANNULA 19FR FEMORAL ARTERIAL 96530-119
|
Facility
|
IP
|
$3,278.00
|
|
| Hospital Charge Code |
2965356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,670.47 |
| Max. Negotiated Rate |
$3,136.39 |
| Rate for Payer: Aetna Commercial |
$3,068.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,931.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.83
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,136.39
|
| Rate for Payer: Health EOS Commercial |
$3,034.12
|
| Rate for Payer: HFN Commercial |
$3,136.39
|
| Rate for Payer: Multiplan Commercial |
$2,727.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,136.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.47
|
| Rate for Payer: Quartz Commercial |
$2,045.47
|
| Rate for Payer: WEA Trust Commercial |
$1,875.02
|
| Rate for Payer: WPS Commercial |
$2,525.04
|
|
|
CANNULA 19FR FEMORAL ARTERIAL 96530-119
|
Facility
|
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.55 |
| Max. Negotiated Rate |
$3,136.39 |
| Rate for Payer: Aetna Commercial |
$3,068.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,931.84
|
| Rate for Payer: Aetna Managed Medicare |
$954.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,215.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,704.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,636.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.83
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,136.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,907.80
|
| Rate for Payer: Health EOS Commercial |
$3,034.12
|
| Rate for Payer: HFN Commercial |
$3,136.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,556.84
|
| Rate for Payer: Multiplan Commercial |
$2,727.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,045.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,136.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.47
|
| Rate for Payer: Quartz Commercial |
$2,215.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,045.47
|
| Rate for Payer: The Alliance Commercial |
$1,704.56
|
| Rate for Payer: WEA Trust Commercial |
$1,875.02
|
| Rate for Payer: WPS Commercial |
$2,525.04
|
|
|
CANNULA 21FR FEMORAL ARTERIAL 96530-121
|
Facility
|
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.55 |
| Max. Negotiated Rate |
$3,136.39 |
| Rate for Payer: Aetna Commercial |
$3,068.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,931.84
|
| Rate for Payer: Aetna Managed Medicare |
$954.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,215.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,704.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,636.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.83
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,136.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,907.80
|
| Rate for Payer: Health EOS Commercial |
$3,034.12
|
| Rate for Payer: HFN Commercial |
$3,136.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,556.84
|
| Rate for Payer: Multiplan Commercial |
$2,727.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,045.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,136.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.47
|
| Rate for Payer: Quartz Commercial |
$2,215.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,045.47
|
| Rate for Payer: The Alliance Commercial |
$1,704.56
|
| Rate for Payer: WEA Trust Commercial |
$1,875.02
|
| Rate for Payer: WPS Commercial |
$2,525.04
|
|
|
CANNULA 21FR FEMORAL ARTERIAL 96530-121
|
Facility
|
IP
|
$3,278.00
|
|
| Hospital Charge Code |
2965357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,670.47 |
| Max. Negotiated Rate |
$3,136.39 |
| Rate for Payer: Aetna Commercial |
$3,068.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,931.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.83
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,136.39
|
| Rate for Payer: Health EOS Commercial |
$3,034.12
|
| Rate for Payer: HFN Commercial |
$3,136.39
|
| Rate for Payer: Multiplan Commercial |
$2,727.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,136.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.47
|
| Rate for Payer: Quartz Commercial |
$2,045.47
|
| Rate for Payer: WEA Trust Commercial |
$1,875.02
|
| Rate for Payer: WPS Commercial |
$2,525.04
|
|
|
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 |
$1,446.68 |
| Max. Negotiated Rate |
$4,753.38 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,443.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,446.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,358.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,583.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,480.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,738.36
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,753.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,891.38
|
| Rate for Payer: Health EOS Commercial |
$4,598.38
|
| Rate for Payer: HFN Commercial |
$4,753.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,875.04
|
| Rate for Payer: Multiplan Commercial |
$4,133.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,100.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,753.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.69
|
| Rate for Payer: Quartz Commercial |
$3,358.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,100.03
|
| Rate for Payer: The Alliance Commercial |
$2,583.36
|
| Rate for Payer: WEA Trust Commercial |
$2,841.70
|
| Rate for Payer: WPS Commercial |
$3,826.85
|
|
|
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 |
$2,531.69 |
| Max. Negotiated Rate |
$4,753.38 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,443.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,738.36
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,753.38
|
| Rate for Payer: Health EOS Commercial |
$4,598.38
|
| Rate for Payer: HFN Commercial |
$4,753.38
|
| Rate for Payer: Multiplan Commercial |
$4,133.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,753.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.69
|
| Rate for Payer: Quartz Commercial |
$3,100.03
|
| Rate for Payer: WEA Trust Commercial |
$2,841.70
|
| Rate for Payer: WPS Commercial |
$3,826.85
|
|
|
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 |
$1,392.23 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,392.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,231.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,486.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,386.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,782.54
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,729.18
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,983.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$3,231.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,983.34
|
| Rate for Payer: The Alliance Commercial |
$2,486.12
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
|
CANNULA 25FR VENOUS FEMORAL MULTI-STAGE PERCUTANEOUS KIT 96880-025
|
Facility
|
IP
|
$4,781.00
|
|
| Hospital Charge Code |
3767526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,436.40 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$2,983.34
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
|
CANNULA 26FR VENOUS ANGLED 67526
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2965373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
CANNULA 26FR VENOUS ANGLED 67526
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2965373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
CANNULA 26FR VENOUS L7208
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.44 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$808.70
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
CANNULA 26FR VENOUS L7208
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Aetna Managed Medicare |
$377.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.27
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.88
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: NAPHCARE Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$876.10
|
| Rate for Payer: Quartz Medicare Advantage |
$808.70
|
| Rate for Payer: The Alliance Commercial |
$673.92
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
CANNULA 27FR FEMORAL VENOUS 96370-027
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
2965358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,170.90 |
| Max. Negotiated Rate |
$4,075.97 |
| Rate for Payer: Aetna Commercial |
$3,987.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,810.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,348.11
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$4,075.97
|
| Rate for Payer: Health EOS Commercial |
$3,943.06
|
| Rate for Payer: HFN Commercial |
$4,075.97
|
| Rate for Payer: Multiplan Commercial |
$3,544.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,075.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.90
|
| Rate for Payer: Quartz Commercial |
$2,658.24
|
| Rate for Payer: WEA Trust Commercial |
$2,436.72
|
| Rate for Payer: WPS Commercial |
$3,281.48
|
|
|
CANNULA 27FR FEMORAL VENOUS 96370-027
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
2965358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,240.51 |
| Max. Negotiated Rate |
$4,075.97 |
| Rate for Payer: Aetna Commercial |
$3,987.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,810.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,240.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,879.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,215.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,126.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,348.11
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$4,075.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,479.32
|
| Rate for Payer: Health EOS Commercial |
$3,943.06
|
| Rate for Payer: HFN Commercial |
$4,075.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,322.80
|
| Rate for Payer: Multiplan Commercial |
$3,544.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,658.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,075.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.90
|
| Rate for Payer: Quartz Commercial |
$2,879.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,658.24
|
| Rate for Payer: The Alliance Commercial |
$2,215.20
|
| Rate for Payer: WEA Trust Commercial |
$2,436.72
|
| Rate for Payer: WPS Commercial |
$3,281.48
|
|
|
CANNULA 27G CHANG HYDRODISSECTION K20-3168
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
5803642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
CANNULA 27G CHANG HYDRODISSECTION K20-3168
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
5803642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$72.80
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
CANNULA 27G HYDRODISSECTION 8065441920
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2969447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CANNULA 27G HYDRODISSECTION 8065441920
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2969447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$82.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.74
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$176.59
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$176.59
|
| Rate for Payer: The Alliance Commercial |
$147.16
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CANNULA 28FR FEMORAL VENOUS 96370-028
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
2965338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,240.51 |
| Max. Negotiated Rate |
$4,075.97 |
| Rate for Payer: Aetna Commercial |
$3,987.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,810.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,240.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,879.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,215.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,126.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,348.11
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$4,075.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,479.32
|
| Rate for Payer: Health EOS Commercial |
$3,943.06
|
| Rate for Payer: HFN Commercial |
$4,075.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,322.80
|
| Rate for Payer: Multiplan Commercial |
$3,544.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,658.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,075.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.90
|
| Rate for Payer: Quartz Commercial |
$2,879.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,658.24
|
| Rate for Payer: The Alliance Commercial |
$2,215.20
|
| Rate for Payer: WEA Trust Commercial |
$2,436.72
|
| Rate for Payer: WPS Commercial |
$3,281.48
|
|
|
CANNULA 28FR FEMORAL VENOUS 96370-028
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
2965338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,170.90 |
| Max. Negotiated Rate |
$4,075.97 |
| Rate for Payer: Aetna Commercial |
$3,987.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,810.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,348.11
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$4,075.97
|
| Rate for Payer: Health EOS Commercial |
$3,943.06
|
| Rate for Payer: HFN Commercial |
$4,075.97
|
| Rate for Payer: Multiplan Commercial |
$3,544.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,075.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.90
|
| Rate for Payer: Quartz Commercial |
$2,658.24
|
| Rate for Payer: WEA Trust Commercial |
$2,436.72
|
| Rate for Payer: WPS Commercial |
$3,281.48
|
|
|
CANNULA 28 FR MALLEABLE VENOUS 68128
|
Facility
|
IP
|
$733.00
|
|
| Hospital Charge Code |
4307167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.54 |
| Max. Negotiated Rate |
$701.33 |
| Rate for Payer: Aetna Commercial |
$686.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.03
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$701.33
|
| Rate for Payer: Health EOS Commercial |
$678.46
|
| Rate for Payer: HFN Commercial |
$701.33
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: Preferred Network Access Commercial |
$701.33
|
| Rate for Payer: Quartz Beloit One Network |
$373.54
|
| Rate for Payer: Quartz Commercial |
$457.39
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
CANNULA 28 FR MALLEABLE VENOUS 68128
|
Facility
|
OP
|
$733.00
|
|
| Hospital Charge Code |
4307167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.45 |
| Max. Negotiated Rate |
$701.33 |
| Rate for Payer: Aetna Commercial |
$686.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Aetna Managed Medicare |
$213.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.03
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$701.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.61
|
| Rate for Payer: Health EOS Commercial |
$678.46
|
| Rate for Payer: HFN Commercial |
$701.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.74
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: NAPHCARE Commercial |
$457.39
|
| Rate for Payer: Preferred Network Access Commercial |
$701.33
|
| Rate for Payer: Quartz Beloit One Network |
$373.54
|
| Rate for Payer: Quartz Commercial |
$495.51
|
| Rate for Payer: Quartz Medicare Advantage |
$457.39
|
| Rate for Payer: The Alliance Commercial |
$381.16
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
CANNULA 28FR VENOUS ANGLED 67528
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2965374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
