|
CATHETER URETERAL DUAL LUMEN 405-100
|
Facility
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2964806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$6,460.00 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.75
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.25
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$1,049.75
|
| Rate for Payer: Quartz Medicare Advantage |
$969.00
|
| Rate for Payer: The Alliance Commercial |
$6,460.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
CATHETER URETHERAL 12F 400612
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
2963384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHERAL 12F 400612
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
2963384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHERAL 8 FR 400608
|
Facility
OP
|
$29.00
|
|
| Hospital Charge Code |
2963445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
CATHETER URETHERAL 8 FR 400608
|
Facility
IP
|
$29.00
|
|
| Hospital Charge Code |
2963445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
CATHETER URETHRAL 16FR 400616
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
2962821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHRAL 16FR 400616
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
2962821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER VANSCHIE5
|
Facility
OP
|
$556.00
|
|
| Hospital Charge Code |
2971412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CATHETER VANSCHIE5
|
Facility
IP
|
$556.00
|
|
| Hospital Charge Code |
2971412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CATHETER VCF 5fr***RECALLED SINCE 2016-CALL TO SEE IF AVAILABLE 3/18
|
Facility
OP
|
$2,960.00
|
|
| Hospital Charge Code |
2971166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.80 |
| Max. Negotiated Rate |
$11,840.00 |
| Rate for Payer: Aetna Commercial |
$2,664.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,545.60
|
| Rate for Payer: Aetna Managed Medicare |
$828.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,924.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,480.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,420.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,568.80
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$2,723.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,656.42
|
| Rate for Payer: Health EOS Commercial |
$2,634.40
|
| Rate for Payer: HFN Commercial |
$2,723.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,220.00
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,776.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,723.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,450.40
|
| Rate for Payer: Quartz Commercial |
$1,924.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,776.00
|
| Rate for Payer: The Alliance Commercial |
$11,840.00
|
| Rate for Payer: WEA Trust Commercial |
$1,628.00
|
| Rate for Payer: WPS Commercial |
$2,192.47
|
|
|
CATHETER VCF 5fr***RECALLED SINCE 2016-CALL TO SEE IF AVAILABLE 3/18
|
Facility
IP
|
$2,960.00
|
|
| Hospital Charge Code |
2971166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,450.40 |
| Max. Negotiated Rate |
$2,723.20 |
| Rate for Payer: Aetna Commercial |
$2,664.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,568.80
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$2,723.20
|
| Rate for Payer: Health EOS Commercial |
$2,634.40
|
| Rate for Payer: HFN Commercial |
$2,723.20
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,776.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,723.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,450.40
|
| Rate for Payer: Quartz Commercial |
$1,776.00
|
| Rate for Payer: WEA Trust Commercial |
$1,628.00
|
| Rate for Payer: WPS Commercial |
$2,192.47
|
|
|
CATHETER VITEK CEREBRAL
|
Facility
IP
|
$427.00
|
|
| Hospital Charge Code |
2971111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER VITEK CEREBRAL
|
Facility
OP
|
$427.00
|
|
| Hospital Charge Code |
2971111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: The Alliance Commercial |
$1,708.00
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER (VOLCANO) EAGLE EYE GOLD #85900
|
Facility
IP
|
$6,605.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2973702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,236.45 |
| Max. Negotiated Rate |
$6,076.60 |
| Rate for Payer: Aetna Commercial |
$5,944.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.65
|
| Rate for Payer: Cash Price |
$1,981.50
|
| Rate for Payer: Cigna Commercial |
$6,076.60
|
| Rate for Payer: Health EOS Commercial |
$5,878.45
|
| Rate for Payer: HFN Commercial |
$6,076.60
|
| Rate for Payer: Multiplan Commercial |
$5,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.45
|
| Rate for Payer: Quartz Commercial |
$3,963.00
|
| Rate for Payer: WEA Trust Commercial |
$3,632.75
|
| Rate for Payer: WPS Commercial |
$4,892.32
|
|
|
CATHETER (VOLCANO) EAGLE EYE GOLD #85900
|
Facility
OP
|
$6,605.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2973702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,849.40 |
| Max. Negotiated Rate |
$6,076.60 |
| Rate for Payer: Aetna Commercial |
$5,944.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,849.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,293.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,302.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.65
|
| Rate for Payer: Cash Price |
$1,981.50
|
| Rate for Payer: Cigna Commercial |
$6,076.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,696.16
|
| Rate for Payer: Health EOS Commercial |
$5,878.45
|
| Rate for Payer: HFN Commercial |
$6,076.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,953.75
|
| Rate for Payer: Multiplan Commercial |
$5,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.45
|
| Rate for Payer: Quartz Commercial |
$4,293.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,963.00
|
| Rate for Payer: WEA Trust Commercial |
$3,632.75
|
| Rate for Payer: WPS Commercial |
$4,892.32
|
|
|
CATHETER (VOLCANO) VISIONS PV MODEL 86700
|
Facility
IP
|
$3,973.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
3107480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,946.77 |
| Max. Negotiated Rate |
$3,655.16 |
| Rate for Payer: Aetna Commercial |
$3,575.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.69
|
| Rate for Payer: Cash Price |
$1,191.90
|
| Rate for Payer: Cigna Commercial |
$3,655.16
|
| Rate for Payer: Health EOS Commercial |
$3,535.97
|
| Rate for Payer: HFN Commercial |
$3,655.16
|
| Rate for Payer: Multiplan Commercial |
$3,178.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,655.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.77
|
| Rate for Payer: Quartz Commercial |
$2,383.80
|
| Rate for Payer: WEA Trust Commercial |
$2,185.15
|
| Rate for Payer: WPS Commercial |
$2,942.80
|
|
|
CATHETER (VOLCANO) VISIONS PV MODEL 86700
|
Facility
OP
|
$3,973.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
3107480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,112.44 |
| Max. Negotiated Rate |
$3,655.16 |
| Rate for Payer: Aetna Commercial |
$3,575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,416.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,112.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,582.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,986.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,907.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.69
|
| Rate for Payer: Cash Price |
$1,191.90
|
| Rate for Payer: Cigna Commercial |
$3,655.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,223.29
|
| Rate for Payer: Health EOS Commercial |
$3,535.97
|
| Rate for Payer: HFN Commercial |
$3,655.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,979.75
|
| Rate for Payer: Multiplan Commercial |
$3,178.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,655.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.77
|
| Rate for Payer: Quartz Commercial |
$2,582.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,383.80
|
| Rate for Payer: WEA Trust Commercial |
$2,185.15
|
| Rate for Payer: WPS Commercial |
$2,942.80
|
|
|
CATHETER WORD BARTHOLIN GLAND 564000
|
Facility
OP
|
$443.00
|
|
| Hospital Charge Code |
2965793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.04 |
| Max. Negotiated Rate |
$1,772.00 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Aetna Managed Medicare |
$124.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.90
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.25
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$287.95
|
| Rate for Payer: Quartz Medicare Advantage |
$265.80
|
| Rate for Payer: The Alliance Commercial |
$1,772.00
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
CATHETER WORD BARTHOLIN GLAND 564000
|
Facility
IP
|
$443.00
|
|
| Hospital Charge Code |
2965793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.07 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$265.80
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
CATHETHER SOLENT OMNI #109681-001
|
Facility
OP
|
$11,716.00
|
|
| Hospital Charge Code |
2973882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,280.48 |
| Max. Negotiated Rate |
$46,864.00 |
| Rate for Payer: Aetna Commercial |
$10,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,075.76
|
| Rate for Payer: Aetna Managed Medicare |
$3,280.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,615.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,623.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,209.48
|
| Rate for Payer: Cash Price |
$3,514.80
|
| Rate for Payer: Cigna Commercial |
$10,778.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,556.27
|
| Rate for Payer: Health EOS Commercial |
$10,427.24
|
| Rate for Payer: HFN Commercial |
$10,778.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,787.00
|
| Rate for Payer: Multiplan Commercial |
$9,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,778.72
|
| Rate for Payer: Quartz Beloit One Network |
$5,740.84
|
| Rate for Payer: Quartz Commercial |
$7,615.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7,029.60
|
| Rate for Payer: The Alliance Commercial |
$46,864.00
|
| Rate for Payer: WEA Trust Commercial |
$6,443.80
|
| Rate for Payer: WPS Commercial |
$8,678.04
|
|
|
CATHETHER SOLENT OMNI #109681-001
|
Facility
IP
|
$11,716.00
|
|
| Hospital Charge Code |
2973882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,740.84 |
| Max. Negotiated Rate |
$10,778.72 |
| Rate for Payer: Aetna Commercial |
$10,544.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,209.48
|
| Rate for Payer: Cash Price |
$3,514.80
|
| Rate for Payer: Cigna Commercial |
$10,778.72
|
| Rate for Payer: Health EOS Commercial |
$10,427.24
|
| Rate for Payer: HFN Commercial |
$10,778.72
|
| Rate for Payer: Multiplan Commercial |
$9,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,778.72
|
| Rate for Payer: Quartz Beloit One Network |
$5,740.84
|
| Rate for Payer: Quartz Commercial |
$7,029.60
|
| Rate for Payer: WEA Trust Commercial |
$6,443.80
|
| Rate for Payer: WPS Commercial |
$8,678.04
|
|
|
CATH FEMORAL ARTERY SAC-00820-PBX
|
Facility
OP
|
$448.00
|
|
| Hospital Charge Code |
5641661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$1,792.00 |
| Rate for Payer: Aetna Commercial |
$403.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Aetna Managed Medicare |
$125.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.44
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$412.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.70
|
| Rate for Payer: Health EOS Commercial |
$398.72
|
| Rate for Payer: HFN Commercial |
$412.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: NAPHCARE Commercial |
$268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$412.16
|
| Rate for Payer: Quartz Beloit One Network |
$219.52
|
| Rate for Payer: Quartz Commercial |
$291.20
|
| Rate for Payer: Quartz Medicare Advantage |
$268.80
|
| Rate for Payer: The Alliance Commercial |
$1,792.00
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
CATH FEMORAL ARTERY SAC-00820-PBX
|
Facility
IP
|
$448.00
|
|
| Hospital Charge Code |
5641661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$412.16 |
| Rate for Payer: Aetna Commercial |
$403.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.44
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$412.16
|
| Rate for Payer: Health EOS Commercial |
$398.72
|
| Rate for Payer: HFN Commercial |
$412.16
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: NAPHCARE Commercial |
$268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$412.16
|
| Rate for Payer: Quartz Beloit One Network |
$219.52
|
| Rate for Payer: Quartz Commercial |
$268.80
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
Cathflow 1 mg Charge
|
Facility
OP
|
$763.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
2958917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.97 |
| Max. Negotiated Rate |
$701.96 |
| Rate for Payer: Aetna Commercial |
$686.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.18
|
| Rate for Payer: Aetna Managed Medicare |
$88.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$366.24
|
| Rate for Payer: Anthem Medicare Advantage |
$88.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.97
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$701.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.97
|
| Rate for Payer: Health EOS Commercial |
$679.07
|
| Rate for Payer: HFN Commercial |
$701.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$330.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.97
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.46
|
| Rate for Payer: Preferred Network Access Commercial |
$701.96
|
| Rate for Payer: Quartz Beloit One Network |
$373.87
|
| Rate for Payer: Quartz Commercial |
$495.95
|
| Rate for Payer: Quartz Medicare Advantage |
$88.97
|
| Rate for Payer: The Alliance Commercial |
$233.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.97
|
| Rate for Payer: WEA Trust Commercial |
$419.65
|
| Rate for Payer: Wellcare Medicare |
$88.97
|
| Rate for Payer: WPS Commercial |
$222.06
|
|
|
Cathflow 1 mg Charge
|
Professional
|
$763.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
2958917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Aetna Commercial |
$724.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.18
|
| Rate for Payer: Aetna Managed Medicare |
$89.15
|
| Rate for Payer: Anthem Medicare Advantage |
$89.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.15
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$724.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$381.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.82
|
| Rate for Payer: Health EOS Commercial |
$694.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.15
|
| Rate for Payer: Multiplan Commercial |
$610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$724.85
|
| Rate for Payer: Quartz Beloit One Network |
$335.72
|
| Rate for Payer: Quartz Commercial |
$434.91
|
| Rate for Payer: Quartz Medicare Advantage |
$89.15
|
| Rate for Payer: The Alliance Commercial |
$245.15
|
| Rate for Payer: United Healthcare Medicaid |
$88.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.15
|
| Rate for Payer: WEA Trust Commercial |
$419.65
|
| Rate for Payer: WPS Commercial |
$222.06
|
|
