|
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
|
|
|
CANNULA 28FR VENOUS L7209
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965152
|
|
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 28FR VENOUS L7209
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965152
|
|
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 29/37 2-STAGE 91229C
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2965299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$188.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$437.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.55
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.66
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$403.73
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$437.37
|
| Rate for Payer: Quartz Medicare Advantage |
$403.73
|
| Rate for Payer: The Alliance Commercial |
$336.44
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
CANNULA 29/37 2-STAGE 91229C
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2965299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.71 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$403.73
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
CANNULA 29FR FEMORAL VENOUS 96370-029
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
2965359
|
|
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 29FR FEMORAL VENOUS 96370-029
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
2965359
|
|
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 2-STAGE VENOUS 32/40FR 91263C
|
Facility
|
IP
|
$772.00
|
|
| Hospital Charge Code |
2965342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.41 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.53
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| Rate for Payer: Multiplan Commercial |
$642.30
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$481.73
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
|
CANNULA 2-STAGE VENOUS 32/40FR 91263C
|
Facility
|
OP
|
$772.00
|
|
| Hospital Charge Code |
2965342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.81 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| Rate for Payer: Aetna Managed Medicare |
$224.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$521.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$401.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$385.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.53
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.30
|
| Rate for Payer: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$602.16
|
| Rate for Payer: Multiplan Commercial |
$642.30
|
| Rate for Payer: NAPHCARE Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$521.87
|
| Rate for Payer: Quartz Medicare Advantage |
$481.73
|
| Rate for Payer: The Alliance Commercial |
$401.44
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
|
CANNULA 30 FR MALLEABLE VENOUS 68130
|
Facility
|
OP
|
$733.00
|
|
| Hospital Charge Code |
4307168
|
|
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 30 FR MALLEABLE VENOUS 68130
|
Facility
|
IP
|
$733.00
|
|
| Hospital Charge Code |
4307168
|
|
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 30FR VENOUS 007210****OBSOLETE 5/2/14
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965153
|
|
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 30FR VENOUS 007210****OBSOLETE 5/2/14
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965153
|
|
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 30FR VENOUS ANGLED 67530
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2965375
|
|
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 30FR VENOUS ANGLED 67530
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2965375
|
|
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 32 FR MALLEABLE VENOUS 68132
|
Facility
|
OP
|
$733.00
|
|
| Hospital Charge Code |
4307169
|
|
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 32 FR MALLEABLE VENOUS 68132
|
Facility
|
IP
|
$733.00
|
|
| Hospital Charge Code |
4307169
|
|
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 32FR VENOUS 007211
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965154
|
|
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 32FR VENOUS 007211
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965154
|
|
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 32FR VENOUS ANGLED 67532
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
2965376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.14 |
| Max. Negotiated Rate |
$1,071.62 |
| Rate for Payer: Aetna Commercial |
$1,048.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.73
|
| Rate for Payer: Aetna Managed Medicare |
$326.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.34
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$1,071.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.84
|
| Rate for Payer: Health EOS Commercial |
$1,036.67
|
| Rate for Payer: HFN Commercial |
$1,071.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.60
|
| Rate for Payer: Multiplan Commercial |
$931.84
|
| Rate for Payer: NAPHCARE Commercial |
$698.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.62
|
| Rate for Payer: Quartz Beloit One Network |
$570.75
|
| Rate for Payer: Quartz Commercial |
$757.12
|
| Rate for Payer: Quartz Medicare Advantage |
$698.88
|
| Rate for Payer: The Alliance Commercial |
$582.40
|
| Rate for Payer: WEA Trust Commercial |
$640.64
|
| Rate for Payer: WPS Commercial |
$862.74
|
|
|
CANNULA 32FR VENOUS ANGLED 67532
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
2965376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.75 |
| Max. Negotiated Rate |
$1,071.62 |
| Rate for Payer: Aetna Commercial |
$1,048.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.34
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$1,071.62
|
| Rate for Payer: Health EOS Commercial |
$1,036.67
|
| Rate for Payer: HFN Commercial |
$1,071.62
|
| Rate for Payer: Multiplan Commercial |
$931.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.62
|
| Rate for Payer: Quartz Beloit One Network |
$570.75
|
| Rate for Payer: Quartz Commercial |
$698.88
|
| Rate for Payer: WEA Trust Commercial |
$640.64
|
| Rate for Payer: WPS Commercial |
$862.74
|
|
|
CANNULA 34 FR MALLEABLE VENOUS 68134
|
Facility
|
OP
|
$733.00
|
|
| Hospital Charge Code |
4287255
|
|
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 34 FR MALLEABLE VENOUS 68134
|
Facility
|
IP
|
$733.00
|
|
| Hospital Charge Code |
4287255
|
|
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 34FR VENOUS ANGLED 67534
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2965377
|
|
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 34FR VENOUS ANGLED 67534
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2965377
|
|
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
|
|
