|
GRAFT 28 X 30 INTERGARD WOVEN STRAIGHT IGW0028-30
|
Facility
|
IP
|
$6,265.00
|
|
| Hospital Charge Code |
2965281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,192.64 |
| Max. Negotiated Rate |
$5,994.35 |
| Rate for Payer: Aetna Commercial |
$5,864.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,603.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,453.27
|
| Rate for Payer: Cash Price |
$1,879.50
|
| Rate for Payer: Cigna Commercial |
$5,994.35
|
| Rate for Payer: Health EOS Commercial |
$5,798.88
|
| Rate for Payer: HFN Commercial |
$5,994.35
|
| Rate for Payer: Multiplan Commercial |
$5,212.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,994.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,192.64
|
| Rate for Payer: Quartz Commercial |
$3,909.36
|
| Rate for Payer: WEA Trust Commercial |
$3,583.58
|
| Rate for Payer: WPS Commercial |
$4,825.93
|
|
|
GRAFT 28 X 30 INTERGARD WOVEN STRAIGHT IGW0028-30
|
Facility
|
OP
|
$6,265.00
|
|
| Hospital Charge Code |
2965281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.37 |
| Max. Negotiated Rate |
$5,994.35 |
| Rate for Payer: Aetna Commercial |
$5,864.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,603.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,824.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,235.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,257.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,127.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,453.27
|
| Rate for Payer: Cash Price |
$1,879.50
|
| Rate for Payer: Cigna Commercial |
$5,994.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.23
|
| Rate for Payer: Health EOS Commercial |
$5,798.88
|
| Rate for Payer: HFN Commercial |
$5,994.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,886.70
|
| Rate for Payer: Multiplan Commercial |
$5,212.48
|
| Rate for Payer: NAPHCARE Commercial |
$3,909.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,994.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,192.64
|
| Rate for Payer: Quartz Commercial |
$4,235.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,909.36
|
| Rate for Payer: The Alliance Commercial |
$3,257.80
|
| Rate for Payer: WEA Trust Commercial |
$3,583.58
|
| Rate for Payer: WPS Commercial |
$4,825.93
|
|
|
GRAFT 30 X 15 INTERGARD WOVEN STRAIGHT IGW0030-15
|
Facility
|
OP
|
$6,265.00
|
|
| Hospital Charge Code |
2964761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.37 |
| Max. Negotiated Rate |
$5,994.35 |
| Rate for Payer: Aetna Commercial |
$5,864.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,603.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,824.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,235.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,257.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,127.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,453.27
|
| Rate for Payer: Cash Price |
$1,879.50
|
| Rate for Payer: Cigna Commercial |
$5,994.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.23
|
| Rate for Payer: Health EOS Commercial |
$5,798.88
|
| Rate for Payer: HFN Commercial |
$5,994.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,886.70
|
| Rate for Payer: Multiplan Commercial |
$5,212.48
|
| Rate for Payer: NAPHCARE Commercial |
$3,909.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,994.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,192.64
|
| Rate for Payer: Quartz Commercial |
$4,235.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,909.36
|
| Rate for Payer: The Alliance Commercial |
$3,257.80
|
| Rate for Payer: WEA Trust Commercial |
$3,583.58
|
| Rate for Payer: WPS Commercial |
$4,825.93
|
|
|
GRAFT 30 X 15 INTERGARD WOVEN STRAIGHT IGW0030-15
|
Facility
|
IP
|
$6,265.00
|
|
| Hospital Charge Code |
2964761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,192.64 |
| Max. Negotiated Rate |
$5,994.35 |
| Rate for Payer: Aetna Commercial |
$5,864.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,603.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,453.27
|
| Rate for Payer: Cash Price |
$1,879.50
|
| Rate for Payer: Cigna Commercial |
$5,994.35
|
| Rate for Payer: Health EOS Commercial |
$5,798.88
|
| Rate for Payer: HFN Commercial |
$5,994.35
|
| Rate for Payer: Multiplan Commercial |
$5,212.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,994.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,192.64
|
| Rate for Payer: Quartz Commercial |
$3,909.36
|
| Rate for Payer: WEA Trust Commercial |
$3,583.58
|
| Rate for Payer: WPS Commercial |
$4,825.93
|
|
|
GRAFT 30 X 30 INTERGARD WOVEN STRAIGHT IGW0030-30
|
Facility
|
OP
|
$5,887.00
|
|
| Hospital Charge Code |
3167477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.29 |
| Max. Negotiated Rate |
$5,632.68 |
| Rate for Payer: Aetna Commercial |
$5,510.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,265.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,714.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,979.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,061.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,938.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.91
|
| Rate for Payer: Cash Price |
$1,766.10
|
| Rate for Payer: Cigna Commercial |
$5,632.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,426.23
|
| Rate for Payer: Health EOS Commercial |
$5,449.01
|
| Rate for Payer: HFN Commercial |
$5,632.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,591.86
|
| Rate for Payer: Multiplan Commercial |
$4,897.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,673.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,632.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,000.02
|
| Rate for Payer: Quartz Commercial |
$3,979.61
|
| Rate for Payer: Quartz Medicare Advantage |
$3,673.49
|
| Rate for Payer: The Alliance Commercial |
$3,061.24
|
| Rate for Payer: WEA Trust Commercial |
$3,367.36
|
| Rate for Payer: WPS Commercial |
$4,534.76
|
|
|
GRAFT 30 X 30 INTERGARD WOVEN STRAIGHT IGW0030-30
|
Facility
|
IP
|
$5,887.00
|
|
| Hospital Charge Code |
3167477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.02 |
| Max. Negotiated Rate |
$5,632.68 |
| Rate for Payer: Aetna Commercial |
$5,510.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,265.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.91
|
| Rate for Payer: Cash Price |
$1,766.10
|
| Rate for Payer: Cigna Commercial |
$5,632.68
|
| Rate for Payer: Health EOS Commercial |
$5,449.01
|
| Rate for Payer: HFN Commercial |
$5,632.68
|
| Rate for Payer: Multiplan Commercial |
$4,897.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,632.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,000.02
|
| Rate for Payer: Quartz Commercial |
$3,673.49
|
| Rate for Payer: WEA Trust Commercial |
$3,367.36
|
| Rate for Payer: WPS Commercial |
$4,534.76
|
|
|
GRAFT 4 X 10CM SEGMENT STR 10S04
|
Facility
|
OP
|
$2,162.00
|
|
| Hospital Charge Code |
2972892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.57 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Aetna Managed Medicare |
$629.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,258.28
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.36
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,349.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,461.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,349.09
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
GRAFT 4 X 10CM SEGMENT STR 10S04
|
Facility
|
IP
|
$2,162.00
|
|
| Hospital Charge Code |
2972892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.76 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,349.09
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
GRAFT 5.0 x 26mm JOS #12748-26
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
GRAFT 5.0 x 26mm JOS #12748-26
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
GRAFT 6 X 10CM SEGMENT STR 10S06
|
Facility
|
OP
|
$2,162.00
|
|
| Hospital Charge Code |
2972893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.57 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Aetna Managed Medicare |
$629.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,258.28
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.36
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,349.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,461.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,349.09
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
GRAFT 6 X 10CM SEGMENT STR 10S06
|
Facility
|
IP
|
$2,162.00
|
|
| Hospital Charge Code |
2972893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.76 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,349.09
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
GRAFT 6 X 40 CENTERFLEX VENAFLO CF4006C
|
Facility
|
OP
|
$8,503.00
|
|
| Hospital Charge Code |
2973736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.07 |
| Max. Negotiated Rate |
$8,135.67 |
| Rate for Payer: Aetna Commercial |
$7,958.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,605.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,476.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,748.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,421.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,244.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,686.85
|
| Rate for Payer: Cash Price |
$2,550.90
|
| Rate for Payer: Cigna Commercial |
$8,135.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,948.75
|
| Rate for Payer: Health EOS Commercial |
$7,870.38
|
| Rate for Payer: HFN Commercial |
$8,135.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,632.34
|
| Rate for Payer: Multiplan Commercial |
$7,074.50
|
| Rate for Payer: NAPHCARE Commercial |
$5,305.87
|
| Rate for Payer: Preferred Network Access Commercial |
$8,135.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,333.13
|
| Rate for Payer: Quartz Commercial |
$5,748.03
|
| Rate for Payer: Quartz Medicare Advantage |
$5,305.87
|
| Rate for Payer: The Alliance Commercial |
$4,421.56
|
| Rate for Payer: WEA Trust Commercial |
$4,863.72
|
| Rate for Payer: WPS Commercial |
$6,549.86
|
|
|
GRAFT 6 X 40 CENTERFLEX VENAFLO CF4006C
|
Facility
|
IP
|
$8,503.00
|
|
| Hospital Charge Code |
2973736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,333.13 |
| Max. Negotiated Rate |
$8,135.67 |
| Rate for Payer: Aetna Commercial |
$7,958.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,605.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,686.85
|
| Rate for Payer: Cash Price |
$2,550.90
|
| Rate for Payer: Cigna Commercial |
$8,135.67
|
| Rate for Payer: Health EOS Commercial |
$7,870.38
|
| Rate for Payer: HFN Commercial |
$8,135.67
|
| Rate for Payer: Multiplan Commercial |
$7,074.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,135.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,333.13
|
| Rate for Payer: Quartz Commercial |
$5,305.87
|
| Rate for Payer: WEA Trust Commercial |
$4,863.72
|
| Rate for Payer: WPS Commercial |
$6,549.86
|
|
|
GRAFT 6x50 CENTERFLEX CF5006
|
Facility
|
OP
|
$6,246.00
|
|
| Hospital Charge Code |
2973691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,818.84 |
| Max. Negotiated Rate |
$5,976.17 |
| Rate for Payer: Aetna Commercial |
$5,846.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,586.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,818.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,222.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,247.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,442.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$5,976.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,635.17
|
| Rate for Payer: Health EOS Commercial |
$5,781.30
|
| Rate for Payer: HFN Commercial |
$5,976.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,871.88
|
| Rate for Payer: Multiplan Commercial |
$5,196.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,897.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,976.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,182.96
|
| Rate for Payer: Quartz Commercial |
$4,222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,897.50
|
| Rate for Payer: The Alliance Commercial |
$3,247.92
|
| Rate for Payer: WEA Trust Commercial |
$3,572.71
|
| Rate for Payer: WPS Commercial |
$4,811.29
|
|
|
GRAFT 6x50 CENTERFLEX CF5006
|
Facility
|
IP
|
$6,246.00
|
|
| Hospital Charge Code |
2973691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,182.96 |
| Max. Negotiated Rate |
$5,976.17 |
| Rate for Payer: Aetna Commercial |
$5,846.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,586.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,442.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$5,976.17
|
| Rate for Payer: Health EOS Commercial |
$5,781.30
|
| Rate for Payer: HFN Commercial |
$5,976.17
|
| Rate for Payer: Multiplan Commercial |
$5,196.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,976.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,182.96
|
| Rate for Payer: Quartz Commercial |
$3,897.50
|
| Rate for Payer: WEA Trust Commercial |
$3,572.71
|
| Rate for Payer: WPS Commercial |
$4,811.29
|
|
|
GRAFT 6x50 FLEX F5006
|
Facility
|
OP
|
$8,503.00
|
|
| Hospital Charge Code |
2969347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.07 |
| Max. Negotiated Rate |
$8,135.67 |
| Rate for Payer: Aetna Commercial |
$7,958.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,605.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,476.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,748.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,421.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,244.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,686.85
|
| Rate for Payer: Cash Price |
$2,550.90
|
| Rate for Payer: Cigna Commercial |
$8,135.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,948.75
|
| Rate for Payer: Health EOS Commercial |
$7,870.38
|
| Rate for Payer: HFN Commercial |
$8,135.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,632.34
|
| Rate for Payer: Multiplan Commercial |
$7,074.50
|
| Rate for Payer: NAPHCARE Commercial |
$5,305.87
|
| Rate for Payer: Preferred Network Access Commercial |
$8,135.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,333.13
|
| Rate for Payer: Quartz Commercial |
$5,748.03
|
| Rate for Payer: Quartz Medicare Advantage |
$5,305.87
|
| Rate for Payer: The Alliance Commercial |
$4,421.56
|
| Rate for Payer: WEA Trust Commercial |
$4,863.72
|
| Rate for Payer: WPS Commercial |
$6,549.86
|
|
|
GRAFT 6x50 FLEX F5006
|
Facility
|
IP
|
$8,503.00
|
|
| Hospital Charge Code |
2969347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,333.13 |
| Max. Negotiated Rate |
$8,135.67 |
| Rate for Payer: Aetna Commercial |
$7,958.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,605.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,686.85
|
| Rate for Payer: Cash Price |
$2,550.90
|
| Rate for Payer: Cigna Commercial |
$8,135.67
|
| Rate for Payer: Health EOS Commercial |
$7,870.38
|
| Rate for Payer: HFN Commercial |
$8,135.67
|
| Rate for Payer: Multiplan Commercial |
$7,074.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,135.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,333.13
|
| Rate for Payer: Quartz Commercial |
$5,305.87
|
| Rate for Payer: WEA Trust Commercial |
$4,863.72
|
| Rate for Payer: WPS Commercial |
$6,549.86
|
|
|
GRAFT 6x70 FLEX F7006
|
Facility
|
IP
|
$8,457.00
|
|
| Hospital Charge Code |
2969349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,309.69 |
| Max. Negotiated Rate |
$8,091.66 |
| Rate for Payer: Aetna Commercial |
$7,915.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,563.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,661.50
|
| Rate for Payer: Cash Price |
$2,537.10
|
| Rate for Payer: Cigna Commercial |
$8,091.66
|
| Rate for Payer: Health EOS Commercial |
$7,827.80
|
| Rate for Payer: HFN Commercial |
$8,091.66
|
| Rate for Payer: Multiplan Commercial |
$7,036.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,091.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,309.69
|
| Rate for Payer: Quartz Commercial |
$5,277.17
|
| Rate for Payer: WEA Trust Commercial |
$4,837.40
|
| Rate for Payer: WPS Commercial |
$6,514.43
|
|
|
GRAFT 6x70 FLEX F7006
|
Facility
|
OP
|
$8,457.00
|
|
| Hospital Charge Code |
2969349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,462.68 |
| Max. Negotiated Rate |
$8,091.66 |
| Rate for Payer: Aetna Commercial |
$7,915.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,563.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,462.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,716.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,397.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,221.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,661.50
|
| Rate for Payer: Cash Price |
$2,537.10
|
| Rate for Payer: Cigna Commercial |
$8,091.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,921.97
|
| Rate for Payer: Health EOS Commercial |
$7,827.80
|
| Rate for Payer: HFN Commercial |
$8,091.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,596.46
|
| Rate for Payer: Multiplan Commercial |
$7,036.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,277.17
|
| Rate for Payer: Preferred Network Access Commercial |
$8,091.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,309.69
|
| Rate for Payer: Quartz Commercial |
$5,716.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5,277.17
|
| Rate for Payer: The Alliance Commercial |
$4,397.64
|
| Rate for Payer: WEA Trust Commercial |
$4,837.40
|
| Rate for Payer: WPS Commercial |
$6,514.43
|
|
|
GRAFT 7-4 X 70CM FLEX TAPER F70T74TWS
|
Facility
|
IP
|
$6,246.00
|
|
| Hospital Charge Code |
2969350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,182.96 |
| Max. Negotiated Rate |
$5,976.17 |
| Rate for Payer: Aetna Commercial |
$5,846.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,586.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,442.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$5,976.17
|
| Rate for Payer: Health EOS Commercial |
$5,781.30
|
| Rate for Payer: HFN Commercial |
$5,976.17
|
| Rate for Payer: Multiplan Commercial |
$5,196.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,976.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,182.96
|
| Rate for Payer: Quartz Commercial |
$3,897.50
|
| Rate for Payer: WEA Trust Commercial |
$3,572.71
|
| Rate for Payer: WPS Commercial |
$4,811.29
|
|
|
GRAFT 7-4 X 70CM FLEX TAPER F70T74TWS
|
Facility
|
OP
|
$6,246.00
|
|
| Hospital Charge Code |
2969350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,818.84 |
| Max. Negotiated Rate |
$5,976.17 |
| Rate for Payer: Aetna Commercial |
$5,846.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,586.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,818.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,222.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,247.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,442.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$5,976.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,635.17
|
| Rate for Payer: Health EOS Commercial |
$5,781.30
|
| Rate for Payer: HFN Commercial |
$5,976.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,871.88
|
| Rate for Payer: Multiplan Commercial |
$5,196.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,897.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,976.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,182.96
|
| Rate for Payer: Quartz Commercial |
$4,222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,897.50
|
| Rate for Payer: The Alliance Commercial |
$3,247.92
|
| Rate for Payer: WEA Trust Commercial |
$3,572.71
|
| Rate for Payer: WPS Commercial |
$4,811.29
|
|
|
GRAFT 8 X 50CM CENTERFLEX CF5008
|
Facility
|
OP
|
$6,246.00
|
|
| Hospital Charge Code |
2973693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,818.84 |
| Max. Negotiated Rate |
$5,976.17 |
| Rate for Payer: Aetna Commercial |
$5,846.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,586.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,818.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,222.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,247.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,442.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$5,976.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,635.17
|
| Rate for Payer: Health EOS Commercial |
$5,781.30
|
| Rate for Payer: HFN Commercial |
$5,976.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,871.88
|
| Rate for Payer: Multiplan Commercial |
$5,196.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,897.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,976.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,182.96
|
| Rate for Payer: Quartz Commercial |
$4,222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,897.50
|
| Rate for Payer: The Alliance Commercial |
$3,247.92
|
| Rate for Payer: WEA Trust Commercial |
$3,572.71
|
| Rate for Payer: WPS Commercial |
$4,811.29
|
|
|
GRAFT 8 X 50CM CENTERFLEX CF5008
|
Facility
|
IP
|
$6,246.00
|
|
| Hospital Charge Code |
2973693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,182.96 |
| Max. Negotiated Rate |
$5,976.17 |
| Rate for Payer: Aetna Commercial |
$5,846.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,586.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,442.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$5,976.17
|
| Rate for Payer: Health EOS Commercial |
$5,781.30
|
| Rate for Payer: HFN Commercial |
$5,976.17
|
| Rate for Payer: Multiplan Commercial |
$5,196.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,976.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,182.96
|
| Rate for Payer: Quartz Commercial |
$3,897.50
|
| Rate for Payer: WEA Trust Commercial |
$3,572.71
|
| Rate for Payer: WPS Commercial |
$4,811.29
|
|
|
GRAFT 8 X 8O FLEX PTFE #F8008
|
Facility
|
IP
|
$8,503.00
|
|
| Hospital Charge Code |
2969351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,333.13 |
| Max. Negotiated Rate |
$8,135.67 |
| Rate for Payer: Aetna Commercial |
$7,958.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,605.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,686.85
|
| Rate for Payer: Cash Price |
$2,550.90
|
| Rate for Payer: Cigna Commercial |
$8,135.67
|
| Rate for Payer: Health EOS Commercial |
$7,870.38
|
| Rate for Payer: HFN Commercial |
$8,135.67
|
| Rate for Payer: Multiplan Commercial |
$7,074.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,135.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,333.13
|
| Rate for Payer: Quartz Commercial |
$5,305.87
|
| Rate for Payer: WEA Trust Commercial |
$4,863.72
|
| Rate for Payer: WPS Commercial |
$6,549.86
|
|
