|
CANNULA AORTIC 24 FR 78424
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
4519628
|
|
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 24FR EZF24TA
|
Facility
|
IP
|
$926.00
|
|
| Hospital Charge Code |
5384873
|
|
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 24FR EZF24TA
|
Facility
|
OP
|
$926.00
|
|
| Hospital Charge Code |
5384873
|
|
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 8.0 5762 ***DISC 7/15
|
Facility
|
OP
|
$920.00
|
|
| Hospital Charge Code |
2965149
|
|
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 AORTIC 8.0 5762 ***DISC 7/15
|
Facility
|
IP
|
$920.00
|
|
| Hospital Charge Code |
2965149
|
|
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 AORTIC ROOT 9FR (12GA) 10012/AR-11012/11012
|
Facility
|
OP
|
$328.00
|
|
| Hospital Charge Code |
2965371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
CANNULA AORTIC ROOT 9FR (12GA) 10012/AR-11012/11012
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
2965371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5767
|
Facility
|
IP
|
$1,282.00
|
|
| Hospital Charge Code |
5074615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.31 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$799.97
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5767
|
Facility
|
OP
|
$1,282.00
|
|
| Hospital Charge Code |
5074615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.32 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$373.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$866.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.96
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$799.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$866.63
|
| Rate for Payer: Quartz Medicare Advantage |
$799.97
|
| Rate for Payer: The Alliance Commercial |
$666.64
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED NON-VENT 4948
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
5074620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED NON-VENT 4948
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
5074620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED VENTED 4949
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
5074619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED VENTED 4949
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
5074619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
CANNULA ARTERIAL 24FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5768
|
Facility
|
OP
|
$1,331.00
|
|
| Hospital Charge Code |
5074616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.59 |
| Max. Negotiated Rate |
$1,273.50 |
| Rate for Payer: Aetna Commercial |
$1,245.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,190.45
|
| Rate for Payer: Aetna Managed Medicare |
$387.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$899.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$692.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$664.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$733.65
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,273.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$774.64
|
| Rate for Payer: Health EOS Commercial |
$1,231.97
|
| Rate for Payer: HFN Commercial |
$1,273.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.18
|
| Rate for Payer: Multiplan Commercial |
$1,107.39
|
| Rate for Payer: NAPHCARE Commercial |
$830.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,273.50
|
| Rate for Payer: Quartz Beloit One Network |
$678.28
|
| Rate for Payer: Quartz Commercial |
$899.76
|
| Rate for Payer: Quartz Medicare Advantage |
$830.54
|
| Rate for Payer: The Alliance Commercial |
$692.12
|
| Rate for Payer: WEA Trust Commercial |
$761.33
|
| Rate for Payer: WPS Commercial |
$1,025.27
|
|
|
CANNULA ARTERIAL 24FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5768
|
Facility
|
IP
|
$1,331.00
|
|
| Hospital Charge Code |
5074616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.28 |
| Max. Negotiated Rate |
$1,273.50 |
| Rate for Payer: Aetna Commercial |
$1,245.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,190.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$733.65
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,273.50
|
| Rate for Payer: Health EOS Commercial |
$1,231.97
|
| Rate for Payer: HFN Commercial |
$1,273.50
|
| Rate for Payer: Multiplan Commercial |
$1,107.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,273.50
|
| Rate for Payer: Quartz Beloit One Network |
$678.28
|
| Rate for Payer: Quartz Commercial |
$830.54
|
| Rate for Payer: WEA Trust Commercial |
$761.33
|
| Rate for Payer: WPS Commercial |
$1,025.27
|
|
|
CANNULA ARTERIAL 24FR/8MM SOFT-FLOW EXTENDED NON-VENT 4950
|
Facility
|
OP
|
$1,256.00
|
|
| Hospital Charge Code |
5349137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.75 |
| Max. Negotiated Rate |
$1,201.74 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Aetna Managed Medicare |
$365.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$849.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$653.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$627.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.99
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.68
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: NAPHCARE Commercial |
$783.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$849.06
|
| Rate for Payer: Quartz Medicare Advantage |
$783.74
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
CANNULA ARTERIAL 24FR/8MM SOFT-FLOW EXTENDED NON-VENT 4950
|
Facility
|
IP
|
$1,256.00
|
|
| Hospital Charge Code |
5349137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$1,201.74 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$783.74
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
CANNULA ARTERIAL EOPA 22FR #77622
|
Facility
|
IP
|
$1,040.00
|
|
| Hospital Charge Code |
4088498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$529.98 |
| Max. Negotiated Rate |
$995.07 |
| Rate for Payer: Aetna Commercial |
$973.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.25
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$995.07
|
| Rate for Payer: Health EOS Commercial |
$962.62
|
| Rate for Payer: HFN Commercial |
$995.07
|
| Rate for Payer: Multiplan Commercial |
$865.28
|
| Rate for Payer: Preferred Network Access Commercial |
$995.07
|
| Rate for Payer: Quartz Beloit One Network |
$529.98
|
| Rate for Payer: Quartz Commercial |
$648.96
|
| Rate for Payer: WEA Trust Commercial |
$594.88
|
| Rate for Payer: WPS Commercial |
$801.11
|
|
|
CANNULA ARTERIAL EOPA 22FR #77622
|
Facility
|
OP
|
$1,040.00
|
|
| Hospital Charge Code |
4088498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.85 |
| Max. Negotiated Rate |
$995.07 |
| Rate for Payer: Aetna Commercial |
$973.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.18
|
| Rate for Payer: Aetna Managed Medicare |
$302.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$703.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$540.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$519.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.25
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$995.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.28
|
| Rate for Payer: Health EOS Commercial |
$962.62
|
| Rate for Payer: HFN Commercial |
$995.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$811.20
|
| Rate for Payer: Multiplan Commercial |
$865.28
|
| Rate for Payer: NAPHCARE Commercial |
$648.96
|
| Rate for Payer: Preferred Network Access Commercial |
$995.07
|
| Rate for Payer: Quartz Beloit One Network |
$529.98
|
| Rate for Payer: Quartz Commercial |
$703.04
|
| Rate for Payer: Quartz Medicare Advantage |
$648.96
|
| Rate for Payer: The Alliance Commercial |
$540.80
|
| Rate for Payer: WEA Trust Commercial |
$594.88
|
| Rate for Payer: WPS Commercial |
$801.11
|
|
|
CANNULA CORONARY ARTERY 9/18FR X 11.4 IN STR PERFUSION (3.0/6.0MM X 290MM) 315806
|
Facility
|
IP
|
$1,361.00
|
|
| Hospital Charge Code |
3167471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.57 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$849.26
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
CANNULA CORONARY ARTERY 9/18FR X 11.4 IN STR PERFUSION (3.0/6.0MM X 290MM) 315806
|
Facility
|
OP
|
$1,361.00
|
|
| Hospital Charge Code |
3167471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.32 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Aetna Managed Medicare |
$396.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$920.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$707.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.10
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.58
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: NAPHCARE Commercial |
$849.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$920.04
|
| Rate for Payer: Quartz Medicare Advantage |
$849.26
|
| Rate for Payer: The Alliance Commercial |
$707.72
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
CANNULA CORONARY ARTERY PERFUSION 5MM 315805
|
Facility
|
IP
|
$1,361.00
|
|
| Hospital Charge Code |
5536764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.57 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$849.26
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
CANNULA CORONARY ARTERY PERFUSION 5MM 315805
|
Facility
|
OP
|
$1,361.00
|
|
| Hospital Charge Code |
5536764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.32 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Aetna Managed Medicare |
$396.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$920.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$707.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.10
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.58
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: NAPHCARE Commercial |
$849.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$920.04
|
| Rate for Payer: Quartz Medicare Advantage |
$849.26
|
| Rate for Payer: The Alliance Commercial |
$707.72
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
CANNULA CORONARY ARTERY PERFUSION 7MM 315807
|
Facility
|
OP
|
$1,361.00
|
|
| Hospital Charge Code |
5536765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.32 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Aetna Managed Medicare |
$396.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$920.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$707.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.10
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.58
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: NAPHCARE Commercial |
$849.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$920.04
|
| Rate for Payer: Quartz Medicare Advantage |
$849.26
|
| Rate for Payer: The Alliance Commercial |
$707.72
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
CANNULA CORONARY ARTERY PERFUSION 7MM 315807
|
Facility
|
IP
|
$1,361.00
|
|
| Hospital Charge Code |
5536765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.57 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$849.26
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
