|
CANNULA 36/46FR 2-STAGE VENOUS 91265C
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2965302
|
|
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 36/46FR 2-STAGE VENOUS 91265C
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2965302
|
|
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 36FR VENOUS L7213
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965156
|
|
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 36FR VENOUS L7213
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965156
|
|
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 4X26 ACCELERATOR III 426-COP
|
Facility
|
IP
|
$367.00
|
|
| Hospital Charge Code |
2965387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CANNULA 4X26 ACCELERATOR III 426-COP
|
Facility
|
OP
|
$367.00
|
|
| Hospital Charge Code |
2965387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$106.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.59
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.26
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$229.01
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$229.01
|
| Rate for Payer: The Alliance Commercial |
$190.84
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CANNULA 5xX6 ACCELERATOR III 526-COP
|
Facility
|
OP
|
$367.00
|
|
| Hospital Charge Code |
2965388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$106.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.59
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.26
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$229.01
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$229.01
|
| Rate for Payer: The Alliance Commercial |
$190.84
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CANNULA 5xX6 ACCELERATOR III 526-COP
|
Facility
|
IP
|
$367.00
|
|
| Hospital Charge Code |
2965388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CANNULA 6MM AORTIC 7072
|
Facility
|
OP
|
$920.00
|
|
| Hospital Charge Code |
2975076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.90 |
| Max. Negotiated Rate |
$880.26 |
| Rate for Payer: Aetna Commercial |
$861.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$822.85
|
| Rate for Payer: Aetna Managed Medicare |
$267.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$621.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$478.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$459.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.10
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$880.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$851.55
|
| Rate for Payer: HFN Commercial |
$880.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: NAPHCARE Commercial |
$574.08
|
| Rate for Payer: Preferred Network Access Commercial |
$880.26
|
| Rate for Payer: Quartz Beloit One Network |
$468.83
|
| Rate for Payer: Quartz Commercial |
$621.92
|
| Rate for Payer: Quartz Medicare Advantage |
$574.08
|
| Rate for Payer: The Alliance Commercial |
$478.40
|
| Rate for Payer: WEA Trust Commercial |
$526.24
|
| Rate for Payer: WPS Commercial |
$708.68
|
|
|
CANNULA 6MM AORTIC 7072
|
Facility
|
IP
|
$920.00
|
|
| Hospital Charge Code |
2975076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.83 |
| Max. Negotiated Rate |
$880.26 |
| Rate for Payer: Aetna Commercial |
$861.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$822.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.10
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$880.26
|
| Rate for Payer: Health EOS Commercial |
$851.55
|
| Rate for Payer: HFN Commercial |
$880.26
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: Preferred Network Access Commercial |
$880.26
|
| Rate for Payer: Quartz Beloit One Network |
$468.83
|
| Rate for Payer: Quartz Commercial |
$574.08
|
| Rate for Payer: WEA Trust Commercial |
$526.24
|
| Rate for Payer: WPS Commercial |
$708.68
|
|
|
CANNULA 6X32 ACCELERATOR III 632-COP
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CANNULA 6X32 ACCELERATOR III 632-COP
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$106.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.59
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.26
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$229.01
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$229.01
|
| Rate for Payer: The Alliance Commercial |
$190.84
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CANNULA 6 X 7 SHOULDER AR-6535
|
Facility
|
OP
|
$645.00
|
|
| Hospital Charge Code |
2964660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$617.14 |
| Rate for Payer: Aetna Commercial |
$603.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Aetna Managed Medicare |
$187.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.52
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$617.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.39
|
| Rate for Payer: Health EOS Commercial |
$597.01
|
| Rate for Payer: HFN Commercial |
$617.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.10
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: NAPHCARE Commercial |
$402.48
|
| Rate for Payer: Preferred Network Access Commercial |
$617.14
|
| Rate for Payer: Quartz Beloit One Network |
$328.69
|
| Rate for Payer: Quartz Commercial |
$436.02
|
| Rate for Payer: Quartz Medicare Advantage |
$402.48
|
| Rate for Payer: The Alliance Commercial |
$335.40
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
CANNULA 6 X 7 SHOULDER AR-6535
|
Facility
|
IP
|
$645.00
|
|
| Hospital Charge Code |
2964660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.69 |
| Max. Negotiated Rate |
$617.14 |
| Rate for Payer: Aetna Commercial |
$603.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.52
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$617.14
|
| Rate for Payer: Health EOS Commercial |
$597.01
|
| Rate for Payer: HFN Commercial |
$617.14
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: Preferred Network Access Commercial |
$617.14
|
| Rate for Payer: Quartz Beloit One Network |
$328.69
|
| Rate for Payer: Quartz Commercial |
$402.48
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
CANNULA 8.25 X 7 SHOULDER AR-6530N
|
Facility
|
IP
|
$645.00
|
|
| Hospital Charge Code |
2964661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.69 |
| Max. Negotiated Rate |
$617.14 |
| Rate for Payer: Aetna Commercial |
$603.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.52
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$617.14
|
| Rate for Payer: Health EOS Commercial |
$597.01
|
| Rate for Payer: HFN Commercial |
$617.14
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: Preferred Network Access Commercial |
$617.14
|
| Rate for Payer: Quartz Beloit One Network |
$328.69
|
| Rate for Payer: Quartz Commercial |
$402.48
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
CANNULA 8.25 X 7 SHOULDER AR-6530N
|
Facility
|
OP
|
$645.00
|
|
| Hospital Charge Code |
2964661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$617.14 |
| Rate for Payer: Aetna Commercial |
$603.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Aetna Managed Medicare |
$187.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.52
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$617.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.39
|
| Rate for Payer: Health EOS Commercial |
$597.01
|
| Rate for Payer: HFN Commercial |
$617.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.10
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: NAPHCARE Commercial |
$402.48
|
| Rate for Payer: Preferred Network Access Commercial |
$617.14
|
| Rate for Payer: Quartz Beloit One Network |
$328.69
|
| Rate for Payer: Quartz Commercial |
$436.02
|
| Rate for Payer: Quartz Medicare Advantage |
$402.48
|
| Rate for Payer: The Alliance Commercial |
$335.40
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
CANNULA ADULT ORAL NASAL #3471ADH-00
|
Facility
|
IP
|
$410.00
|
|
| Hospital Charge Code |
2973055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$255.84
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
CANNULA ADULT ORAL NASAL #3471ADH-00
|
Facility
|
OP
|
$410.00
|
|
| Hospital Charge Code |
2973055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$119.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.62
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.80
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$255.84
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$277.16
|
| Rate for Payer: Quartz Medicare Advantage |
$255.84
|
| Rate for Payer: The Alliance Commercial |
$213.20
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
CANNULA ANTERIOR CHAMBER 27GA 8065420120
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
4518847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$29.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.56
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$63.65
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$63.65
|
| Rate for Payer: The Alliance Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
CANNULA ANTERIOR CHAMBER 27GA 8065420120
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
4518847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
CANNULA AORTIC 21FR EZF21TA
|
Facility
|
IP
|
$926.00
|
|
| Hospital Charge Code |
5384872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$866.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.41
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$886.00
|
| Rate for Payer: Health EOS Commercial |
$857.11
|
| Rate for Payer: HFN Commercial |
$886.00
|
| Rate for Payer: Multiplan Commercial |
$770.43
|
| Rate for Payer: Preferred Network Access Commercial |
$886.00
|
| Rate for Payer: Quartz Beloit One Network |
$471.89
|
| Rate for Payer: Quartz Commercial |
$577.82
|
| Rate for Payer: WEA Trust Commercial |
$529.67
|
| Rate for Payer: WPS Commercial |
$713.30
|
|
|
CANNULA AORTIC 21FR EZF21TA
|
Facility
|
OP
|
$926.00
|
|
| Hospital Charge Code |
5384872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.65 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$866.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.21
|
| Rate for Payer: Aetna Managed Medicare |
$269.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.41
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$886.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.93
|
| Rate for Payer: Health EOS Commercial |
$857.11
|
| Rate for Payer: HFN Commercial |
$886.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.28
|
| Rate for Payer: Multiplan Commercial |
$770.43
|
| Rate for Payer: NAPHCARE Commercial |
$577.82
|
| Rate for Payer: Preferred Network Access Commercial |
$886.00
|
| Rate for Payer: Quartz Beloit One Network |
$471.89
|
| Rate for Payer: Quartz Commercial |
$625.98
|
| Rate for Payer: Quartz Medicare Advantage |
$577.82
|
| Rate for Payer: The Alliance Commercial |
$481.52
|
| Rate for Payer: WEA Trust Commercial |
$529.67
|
| Rate for Payer: WPS Commercial |
$713.30
|
|
|
CANNULA AORTIC 22 FR 78422
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
4519627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.50 |
| Max. Negotiated Rate |
$797.01 |
| Rate for Payer: Aetna Commercial |
$779.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$745.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.15
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$797.01
|
| Rate for Payer: Health EOS Commercial |
$771.02
|
| Rate for Payer: HFN Commercial |
$797.01
|
| Rate for Payer: Multiplan Commercial |
$693.06
|
| Rate for Payer: Preferred Network Access Commercial |
$797.01
|
| Rate for Payer: Quartz Beloit One Network |
$424.50
|
| Rate for Payer: Quartz Commercial |
$519.79
|
| Rate for Payer: WEA Trust Commercial |
$476.48
|
| Rate for Payer: WPS Commercial |
$641.66
|
|
|
CANNULA AORTIC 22 FR 78422
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
4519627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.57 |
| Max. Negotiated Rate |
$797.01 |
| Rate for Payer: Aetna Commercial |
$779.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$745.04
|
| Rate for Payer: Aetna Managed Medicare |
$242.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$433.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$415.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.15
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$797.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.81
|
| Rate for Payer: Health EOS Commercial |
$771.02
|
| Rate for Payer: HFN Commercial |
$797.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$649.74
|
| Rate for Payer: Multiplan Commercial |
$693.06
|
| Rate for Payer: NAPHCARE Commercial |
$519.79
|
| Rate for Payer: Preferred Network Access Commercial |
$797.01
|
| Rate for Payer: Quartz Beloit One Network |
$424.50
|
| Rate for Payer: Quartz Commercial |
$563.11
|
| Rate for Payer: Quartz Medicare Advantage |
$519.79
|
| Rate for Payer: The Alliance Commercial |
$433.16
|
| Rate for Payer: WEA Trust Commercial |
$476.48
|
| Rate for Payer: WPS Commercial |
$641.66
|
|
|
CANNULA AORTIC 24 FR 78424
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
4519628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.50 |
| Max. Negotiated Rate |
$797.01 |
| Rate for Payer: Aetna Commercial |
$779.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$745.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.15
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$797.01
|
| Rate for Payer: Health EOS Commercial |
$771.02
|
| Rate for Payer: HFN Commercial |
$797.01
|
| Rate for Payer: Multiplan Commercial |
$693.06
|
| Rate for Payer: Preferred Network Access Commercial |
$797.01
|
| Rate for Payer: Quartz Beloit One Network |
$424.50
|
| Rate for Payer: Quartz Commercial |
$519.79
|
| Rate for Payer: WEA Trust Commercial |
$476.48
|
| Rate for Payer: WPS Commercial |
$641.66
|
|
