|
5Fr Temp Balloon Pace
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
2550868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,207.24 |
| Max. Negotiated Rate |
$2,266.66 |
| Rate for Payer: Aetna Commercial |
$2,217.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,118.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.79
|
| Rate for Payer: Cash Price |
$710.70
|
| Rate for Payer: Cigna Commercial |
$2,266.66
|
| Rate for Payer: Health EOS Commercial |
$2,192.75
|
| Rate for Payer: HFN Commercial |
$2,266.66
|
| Rate for Payer: Multiplan Commercial |
$1,971.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,266.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,207.24
|
| Rate for Payer: Quartz Commercial |
$1,478.26
|
| Rate for Payer: WEA Trust Commercial |
$1,355.07
|
| Rate for Payer: WPS Commercial |
$1,824.84
|
|
|
5FR Woven Flexie EP Catheter
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4534614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.94 |
| Max. Negotiated Rate |
$2,779.50 |
| Rate for Payer: Aetna Commercial |
$2,719.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.23
|
| Rate for Payer: Aetna Managed Medicare |
$845.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,963.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,510.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.24
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cigna Commercial |
$2,779.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,690.71
|
| Rate for Payer: Health EOS Commercial |
$2,688.87
|
| Rate for Payer: HFN Commercial |
$2,779.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.90
|
| Rate for Payer: Multiplan Commercial |
$2,416.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.39
|
| Rate for Payer: Quartz Commercial |
$1,963.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,812.72
|
| Rate for Payer: The Alliance Commercial |
$1,510.60
|
| Rate for Payer: WEA Trust Commercial |
$1,661.66
|
| Rate for Payer: WPS Commercial |
$2,237.72
|
|
|
5FR Woven Flexie EP Catheter
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4534614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.39 |
| Max. Negotiated Rate |
$2,779.50 |
| Rate for Payer: Aetna Commercial |
$2,719.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.24
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cigna Commercial |
$2,779.50
|
| Rate for Payer: Health EOS Commercial |
$2,688.87
|
| Rate for Payer: HFN Commercial |
$2,779.50
|
| Rate for Payer: Multiplan Commercial |
$2,416.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.39
|
| Rate for Payer: Quartz Commercial |
$1,812.72
|
| Rate for Payer: WEA Trust Commercial |
$1,661.66
|
| Rate for Payer: WPS Commercial |
$2,237.72
|
|
|
5' Nucleotidase
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
977768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$11.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.25
|
| Rate for Payer: Anthem Medicare Advantage |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.60
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.60
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$17.39
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$11.60
|
| Rate for Payer: The Alliance Commercial |
$46.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.60
|
| Rate for Payer: United Healthcare PPO |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: Wellcare Medicare |
$11.60
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
5' Nucleotidase
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
977768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$343.82 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$11.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.60
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$343.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.60
|
| Rate for Payer: Health EOS Commercial |
$329.35
|
| Rate for Payer: HFN Commercial |
$343.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$17.39
|
| Rate for Payer: Preferred Network Access Commercial |
$343.82
|
| Rate for Payer: Quartz Beloit One Network |
$159.24
|
| Rate for Payer: Quartz Commercial |
$206.29
|
| Rate for Payer: Quartz Medicare Advantage |
$11.60
|
| Rate for Payer: The Alliance Commercial |
$45.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.60
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$51.02
|
|
|
5' Nucleotidase
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
977768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
60 Ml Syringe
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040361
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
60 Ml Syringe
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040361
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
6-35 Months Preservative Free 90655
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 90655
|
| Hospital Charge Code |
3795876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$35.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.46
|
| Rate for Payer: Health EOS Commercial |
$34.07
|
| Rate for Payer: HFN Commercial |
$35.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.18
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$35.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.47
|
| Rate for Payer: Quartz Commercial |
$21.34
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
6-35 Months Preservative Free 90655
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 90655
|
| Hospital Charge Code |
3795876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
6-35 Months Preservative Free 90655
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 90655
|
| Hospital Charge Code |
3795876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
6-acetyl Morphine
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
5144675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$83.26 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.44
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
6-acetyl Morphine
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
5144675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
6-acetyl Morphine
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
5144675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
6FR-23CM Brite Tip Sheath
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4606627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
6FR-23CM Brite Tip Sheath
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4606627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
6FR ANGEL SHEATH-55CM
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.89 |
| Max. Negotiated Rate |
$827.63 |
| Rate for Payer: Aetna Commercial |
$809.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$773.66
|
| Rate for Payer: Aetna Managed Medicare |
$251.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$584.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$449.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$431.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.79
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$827.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$503.43
|
| Rate for Payer: Health EOS Commercial |
$800.64
|
| Rate for Payer: HFN Commercial |
$827.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.70
|
| Rate for Payer: Multiplan Commercial |
$719.68
|
| Rate for Payer: NAPHCARE Commercial |
$539.76
|
| Rate for Payer: Preferred Network Access Commercial |
$827.63
|
| Rate for Payer: Quartz Beloit One Network |
$440.80
|
| Rate for Payer: Quartz Commercial |
$584.74
|
| Rate for Payer: Quartz Medicare Advantage |
$539.76
|
| Rate for Payer: The Alliance Commercial |
$449.80
|
| Rate for Payer: WEA Trust Commercial |
$494.78
|
| Rate for Payer: WPS Commercial |
$666.31
|
|
|
6FR ANGEL SHEATH-55CM
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.80 |
| Max. Negotiated Rate |
$827.63 |
| Rate for Payer: Aetna Commercial |
$809.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$773.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.79
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$827.63
|
| Rate for Payer: Health EOS Commercial |
$800.64
|
| Rate for Payer: HFN Commercial |
$827.63
|
| Rate for Payer: Multiplan Commercial |
$719.68
|
| Rate for Payer: Preferred Network Access Commercial |
$827.63
|
| Rate for Payer: Quartz Beloit One Network |
$440.80
|
| Rate for Payer: Quartz Commercial |
$539.76
|
| Rate for Payer: WEA Trust Commercial |
$494.78
|
| Rate for Payer: WPS Commercial |
$666.31
|
|
|
6FR ANGEL SHEATH-70CM
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.32 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.22
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.38
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: NAPHCARE Commercial |
$637.10
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$690.20
|
| Rate for Payer: Quartz Medicare Advantage |
$637.10
|
| Rate for Payer: The Alliance Commercial |
$530.92
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
6FR ANGEL SHEATH-70CM
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.30 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$637.10
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
6FR Deca EP Catheter
|
Facility
|
IP
|
$3,870.00
|
|
| Hospital Charge Code |
4534610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,972.15 |
| Max. Negotiated Rate |
$3,702.82 |
| Rate for Payer: Aetna Commercial |
$3,622.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,461.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,133.14
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$3,702.82
|
| Rate for Payer: Health EOS Commercial |
$3,582.07
|
| Rate for Payer: HFN Commercial |
$3,702.82
|
| Rate for Payer: Multiplan Commercial |
$3,219.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,702.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,972.15
|
| Rate for Payer: Quartz Commercial |
$2,414.88
|
| Rate for Payer: WEA Trust Commercial |
$2,213.64
|
| Rate for Payer: WPS Commercial |
$2,981.06
|
|
|
6FR Deca EP Catheter
|
Facility
|
OP
|
$3,870.00
|
|
| Hospital Charge Code |
4534610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,126.94 |
| Max. Negotiated Rate |
$3,702.82 |
| Rate for Payer: Aetna Commercial |
$3,622.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,461.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,126.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,616.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,012.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,931.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,133.14
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$3,702.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,252.34
|
| Rate for Payer: Health EOS Commercial |
$3,582.07
|
| Rate for Payer: HFN Commercial |
$3,702.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,018.60
|
| Rate for Payer: Multiplan Commercial |
$3,219.84
|
| Rate for Payer: NAPHCARE Commercial |
$2,414.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,702.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,972.15
|
| Rate for Payer: Quartz Commercial |
$2,616.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,414.88
|
| Rate for Payer: The Alliance Commercial |
$2,012.40
|
| Rate for Payer: WEA Trust Commercial |
$2,213.64
|
| Rate for Payer: WPS Commercial |
$2,981.06
|
|
|
6FR Guide Liner
|
Facility
|
OP
|
$5,833.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.57 |
| Max. Negotiated Rate |
$5,581.01 |
| Rate for Payer: Aetna Commercial |
$5,459.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,217.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,698.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,943.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,033.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,911.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,215.15
|
| Rate for Payer: Cash Price |
$1,749.90
|
| Rate for Payer: Cigna Commercial |
$5,581.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,394.81
|
| Rate for Payer: Health EOS Commercial |
$5,399.02
|
| Rate for Payer: HFN Commercial |
$5,581.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,549.74
|
| Rate for Payer: Multiplan Commercial |
$4,853.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,581.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.50
|
| Rate for Payer: Quartz Commercial |
$3,943.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,639.79
|
| Rate for Payer: The Alliance Commercial |
$3,033.16
|
| Rate for Payer: WEA Trust Commercial |
$3,336.48
|
| Rate for Payer: WPS Commercial |
$4,493.16
|
|
|
6FR Guide Liner
|
Facility
|
IP
|
$5,833.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,972.50 |
| Max. Negotiated Rate |
$5,581.01 |
| Rate for Payer: Aetna Commercial |
$5,459.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,217.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,215.15
|
| Rate for Payer: Cash Price |
$1,749.90
|
| Rate for Payer: Cigna Commercial |
$5,581.01
|
| Rate for Payer: Health EOS Commercial |
$5,399.02
|
| Rate for Payer: HFN Commercial |
$5,581.01
|
| Rate for Payer: Multiplan Commercial |
$4,853.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,581.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.50
|
| Rate for Payer: Quartz Commercial |
$3,639.79
|
| Rate for Payer: WEA Trust Commercial |
$3,336.48
|
| Rate for Payer: WPS Commercial |
$4,493.16
|
|
|
6FR SHEATH-55CM
|
Facility
|
OP
|
$1,408.00
|
|
| Hospital Charge Code |
6175141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Aetna Managed Medicare |
$410.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.46
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.24
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$878.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$951.81
|
| Rate for Payer: Quartz Medicare Advantage |
$878.59
|
| Rate for Payer: The Alliance Commercial |
$732.16
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
