|
5Fr Temp Balloon Pace
|
Facility
IP
|
$2,369.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
2550868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,160.81 |
| Max. Negotiated Rate |
$2,179.48 |
| Rate for Payer: Aetna Commercial |
$2,132.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.57
|
| Rate for Payer: Cash Price |
$710.70
|
| Rate for Payer: Cigna Commercial |
$2,179.48
|
| Rate for Payer: Health EOS Commercial |
$2,108.41
|
| Rate for Payer: HFN Commercial |
$2,179.48
|
| Rate for Payer: Multiplan Commercial |
$1,895.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,421.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,179.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.81
|
| Rate for Payer: Quartz Commercial |
$1,421.40
|
| Rate for Payer: WEA Trust Commercial |
$1,302.95
|
| Rate for Payer: WPS Commercial |
$1,754.72
|
|
|
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 |
$813.40 |
| Max. Negotiated Rate |
$2,672.60 |
| Rate for Payer: Aetna Commercial |
$2,614.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.30
|
| Rate for Payer: Aetna Managed Medicare |
$813.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,888.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,452.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,394.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.65
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cigna Commercial |
$2,672.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,625.64
|
| Rate for Payer: Health EOS Commercial |
$2,585.45
|
| Rate for Payer: HFN Commercial |
$2,672.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,178.75
|
| Rate for Payer: Multiplan Commercial |
$2,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,743.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.45
|
| Rate for Payer: Quartz Commercial |
$1,888.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,743.00
|
| Rate for Payer: WEA Trust Commercial |
$1,597.75
|
| Rate for Payer: WPS Commercial |
$2,151.73
|
|
|
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 |
$1,423.45 |
| Max. Negotiated Rate |
$2,672.60 |
| Rate for Payer: Aetna Commercial |
$2,614.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.65
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cigna Commercial |
$2,672.60
|
| Rate for Payer: Health EOS Commercial |
$2,585.45
|
| Rate for Payer: HFN Commercial |
$2,672.60
|
| Rate for Payer: Multiplan Commercial |
$2,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,743.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.45
|
| Rate for Payer: Quartz Commercial |
$1,743.00
|
| Rate for Payer: WEA Trust Commercial |
$1,597.75
|
| Rate for Payer: WPS Commercial |
$2,151.73
|
|
|
5' Nucleotidase
|
Professional
|
$348.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
977768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna Commercial |
$330.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$11.15
|
| Rate for Payer: Anthem Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.15
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$330.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.15
|
| Rate for Payer: Health EOS Commercial |
$316.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.15
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.60
|
| Rate for Payer: Quartz Beloit One Network |
$153.12
|
| Rate for Payer: Quartz Commercial |
$198.36
|
| Rate for Payer: Quartz Medicare Advantage |
$11.15
|
| Rate for Payer: The Alliance Commercial |
$44.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.15
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$49.06
|
|
|
5' Nucleotidase
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
977768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
5' Nucleotidase
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
977768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$11.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.51
|
| Rate for Payer: Anthem Medicaid |
$11.52
|
| Rate for Payer: Anthem Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.15
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.52
|
| Rate for Payer: Dean Health Medicaid |
$11.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.15
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.15
|
| Rate for Payer: Managed Health Services Medicaid |
$11.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.15
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.72
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.52
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11.15
|
| Rate for Payer: The Alliance Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.15
|
| Rate for Payer: United Healthcare PPO |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: Wellcare Medicare |
$11.15
|
| Rate for Payer: WMAP Medicaid |
$11.52
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
60 Ml Syringe
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
3040361
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
60 Ml Syringe
|
Facility
IP
|
$1.00
|
|
| Hospital Charge Code |
3040361
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
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 |
$10.08 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.15
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
6-35 Months Preservative Free 90655
|
Professional
|
$36.00
|
|
|
Service Code
|
CPT 90655
|
| Hospital Charge Code |
3795876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.60
|
| Rate for Payer: Health EOS Commercial |
$32.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.17
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.20
|
| Rate for Payer: Quartz Beloit One Network |
$15.84
|
| Rate for Payer: Quartz Commercial |
$20.52
|
| Rate for Payer: The Alliance Commercial |
$18.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
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 |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
6-acetyl Morphine
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
5144675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: United Healthcare PPO |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
6-acetyl Morphine
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
5144675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
6-acetyl Morphine
|
Professional
|
$60.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
5144675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$80.06 |
| Rate for Payer: Aetna Commercial |
$57.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.00
|
| Rate for Payer: Health EOS Commercial |
$54.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$57.00
|
| Rate for Payer: Quartz Beloit One Network |
$26.40
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
6FR-23CM Brite Tip Sheath
|
Facility
OP
|
$471.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4606627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Aetna Managed Medicare |
$131.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.57
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$353.25
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$282.60
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$306.15
|
| Rate for Payer: Quartz Medicare Advantage |
$282.60
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
6FR-23CM Brite Tip Sheath
|
Facility
IP
|
$471.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4606627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.79 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$282.60
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$282.60
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
6FR ANGEL SHEATH-55CM
|
Facility
IP
|
$865.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.85 |
| Max. Negotiated Rate |
$795.80 |
| Rate for Payer: Aetna Commercial |
$778.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.45
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$795.80
|
| Rate for Payer: Health EOS Commercial |
$769.85
|
| Rate for Payer: HFN Commercial |
$795.80
|
| Rate for Payer: Multiplan Commercial |
$692.00
|
| Rate for Payer: NAPHCARE Commercial |
$519.00
|
| Rate for Payer: Preferred Network Access Commercial |
$795.80
|
| Rate for Payer: Quartz Beloit One Network |
$423.85
|
| Rate for Payer: Quartz Commercial |
$519.00
|
| Rate for Payer: WEA Trust Commercial |
$475.75
|
| Rate for Payer: WPS Commercial |
$640.71
|
|
|
6FR ANGEL SHEATH-55CM
|
Facility
OP
|
$865.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$795.80 |
| Rate for Payer: Aetna Commercial |
$778.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.90
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$562.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$432.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$415.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.45
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$795.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.05
|
| Rate for Payer: Health EOS Commercial |
$769.85
|
| Rate for Payer: HFN Commercial |
$795.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.75
|
| Rate for Payer: Multiplan Commercial |
$692.00
|
| Rate for Payer: NAPHCARE Commercial |
$519.00
|
| Rate for Payer: Preferred Network Access Commercial |
$795.80
|
| Rate for Payer: Quartz Beloit One Network |
$423.85
|
| Rate for Payer: Quartz Commercial |
$562.25
|
| Rate for Payer: Quartz Medicare Advantage |
$519.00
|
| Rate for Payer: WEA Trust Commercial |
$475.75
|
| Rate for Payer: WPS Commercial |
$640.71
|
|
|
6FR ANGEL SHEATH-70CM
|
Facility
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.29 |
| Max. Negotiated Rate |
$939.32 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$612.60
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
6FR ANGEL SHEATH-70CM
|
Facility
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5282610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.88 |
| Max. Negotiated Rate |
$939.32 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Aetna Managed Medicare |
$285.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.35
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.75
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$663.65
|
| Rate for Payer: Quartz Medicare Advantage |
$612.60
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
6FR Deca EP Catheter
|
Facility
IP
|
$3,870.00
|
|
| Hospital Charge Code |
4534610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,896.30 |
| Max. Negotiated Rate |
$3,560.40 |
| Rate for Payer: Aetna Commercial |
$3,483.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,051.10
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$3,560.40
|
| Rate for Payer: Health EOS Commercial |
$3,444.30
|
| Rate for Payer: HFN Commercial |
$3,560.40
|
| Rate for Payer: Multiplan Commercial |
$3,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,322.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,560.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,896.30
|
| Rate for Payer: Quartz Commercial |
$2,322.00
|
| Rate for Payer: WEA Trust Commercial |
$2,128.50
|
| Rate for Payer: WPS Commercial |
$2,866.51
|
|
|
6FR Deca EP Catheter
|
Facility
OP
|
$3,870.00
|
|
| Hospital Charge Code |
4534610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,083.60 |
| Max. Negotiated Rate |
$15,480.00 |
| Rate for Payer: Aetna Commercial |
$3,483.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,328.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,083.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,515.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,935.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,857.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,051.10
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$3,560.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,165.65
|
| Rate for Payer: Health EOS Commercial |
$3,444.30
|
| Rate for Payer: HFN Commercial |
$3,560.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,902.50
|
| Rate for Payer: Multiplan Commercial |
$3,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,322.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,560.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,896.30
|
| Rate for Payer: Quartz Commercial |
$2,515.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,322.00
|
| Rate for Payer: The Alliance Commercial |
$15,480.00
|
| Rate for Payer: WEA Trust Commercial |
$2,128.50
|
| Rate for Payer: WPS Commercial |
$2,866.51
|
|
|
6FR Guide Liner
|
Facility
IP
|
$5,833.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.17 |
| Max. Negotiated Rate |
$5,366.36 |
| Rate for Payer: Aetna Commercial |
$5,249.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,091.49
|
| Rate for Payer: Cash Price |
$1,749.90
|
| Rate for Payer: Cigna Commercial |
$5,366.36
|
| Rate for Payer: Health EOS Commercial |
$5,191.37
|
| Rate for Payer: HFN Commercial |
$5,366.36
|
| Rate for Payer: Multiplan Commercial |
$4,666.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,366.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,858.17
|
| Rate for Payer: Quartz Commercial |
$3,499.80
|
| Rate for Payer: WEA Trust Commercial |
$3,208.15
|
| Rate for Payer: WPS Commercial |
$4,320.50
|
|
|
6FR Guide Liner
|
Facility
OP
|
$5,833.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.24 |
| Max. Negotiated Rate |
$5,366.36 |
| Rate for Payer: Aetna Commercial |
$5,249.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,016.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,633.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,791.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,916.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,799.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,091.49
|
| Rate for Payer: Cash Price |
$1,749.90
|
| Rate for Payer: Cigna Commercial |
$5,366.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,264.15
|
| Rate for Payer: Health EOS Commercial |
$5,191.37
|
| Rate for Payer: HFN Commercial |
$5,366.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,374.75
|
| Rate for Payer: Multiplan Commercial |
$4,666.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,366.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,858.17
|
| Rate for Payer: Quartz Commercial |
$3,791.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,499.80
|
| Rate for Payer: WEA Trust Commercial |
$3,208.15
|
| Rate for Payer: WPS Commercial |
$4,320.50
|
|
|
6FR SHEATH-55CM
|
Facility
IP
|
$1,408.00
|
|
| Hospital Charge Code |
6175141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$1,295.36 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$844.80
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
