|
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
|
|
|
CATH.FOGARTY IRRIG.10 FR***DISC** DEDE 4/21
|
Facility
OP
|
$526.00
|
|
| Hospital Charge Code |
2963452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$2,104.00 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$147.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.35
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.50
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| Rate for Payer: Quartz Medicare Advantage |
$315.60
|
| Rate for Payer: The Alliance Commercial |
$2,104.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
CATH.FOGARTY IRRIG.10 FR***DISC** DEDE 4/21
|
Facility
IP
|
$526.00
|
|
| Hospital Charge Code |
2963452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
CATH GARD SHIELD 7 & 7.5 FR
|
Facility
OP
|
$274.00
|
|
| Hospital Charge Code |
2962976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$76.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.33
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$164.40
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
CATH GARD SHIELD 7 & 7.5 FR
|
Facility
IP
|
$274.00
|
|
| Hospital Charge Code |
2962976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
CATH GARD SHIELD 8 & 8.5 FR
|
Facility
OP
|
$274.00
|
|
| Hospital Charge Code |
2962950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$76.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.33
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$164.40
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
CATH GARD SHIELD 8 & 8.5 FR
|
Facility
IP
|
$274.00
|
|
| Hospital Charge Code |
2962950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
CATH HICKMAN 8F SINGLE LUMEN
|
Facility
OP
|
$1,244.00
|
|
| Hospital Charge Code |
2963170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.32 |
| Max. Negotiated Rate |
$4,976.00 |
| Rate for Payer: Aetna Commercial |
$1,119.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,069.84
|
| Rate for Payer: Aetna Managed Medicare |
$348.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$808.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.32
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.14
|
| Rate for Payer: Health EOS Commercial |
$1,107.16
|
| Rate for Payer: HFN Commercial |
$1,144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.00
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: NAPHCARE Commercial |
$746.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.48
|
| Rate for Payer: Quartz Beloit One Network |
$609.56
|
| Rate for Payer: Quartz Commercial |
$808.60
|
| Rate for Payer: Quartz Medicare Advantage |
$746.40
|
| Rate for Payer: The Alliance Commercial |
$4,976.00
|
| Rate for Payer: WEA Trust Commercial |
$684.20
|
| Rate for Payer: WPS Commercial |
$921.43
|
|
|
CATH HICKMAN 8F SINGLE LUMEN
|
Facility
IP
|
$1,244.00
|
|
| Hospital Charge Code |
2963170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$609.56 |
| Max. Negotiated Rate |
$1,144.48 |
| Rate for Payer: Aetna Commercial |
$1,119.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.32
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,144.48
|
| Rate for Payer: Health EOS Commercial |
$1,107.16
|
| Rate for Payer: HFN Commercial |
$1,144.48
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: NAPHCARE Commercial |
$746.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.48
|
| Rate for Payer: Quartz Beloit One Network |
$609.56
|
| Rate for Payer: Quartz Commercial |
$746.40
|
| Rate for Payer: WEA Trust Commercial |
$684.20
|
| Rate for Payer: WPS Commercial |
$921.43
|
|
|
CATH IAB SENSATION PLUS 40CC 0684-00-0568-01U
|
Facility
IP
|
$1,515.00
|
|
| Hospital Charge Code |
4594855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.35 |
| Max. Negotiated Rate |
$1,393.80 |
| Rate for Payer: Aetna Commercial |
$1,363.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.95
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,393.80
|
| Rate for Payer: Health EOS Commercial |
$1,348.35
|
| Rate for Payer: HFN Commercial |
$1,393.80
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$909.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.80
|
| Rate for Payer: Quartz Beloit One Network |
$742.35
|
| Rate for Payer: Quartz Commercial |
$909.00
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
CATH IAB SENSATION PLUS 40CC 0684-00-0568-01U
|
Facility
OP
|
$1,515.00
|
|
| Hospital Charge Code |
4594855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$6,060.00 |
| Rate for Payer: Aetna Commercial |
$1,363.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.90
|
| Rate for Payer: Aetna Managed Medicare |
$424.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.95
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,393.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.79
|
| Rate for Payer: Health EOS Commercial |
$1,348.35
|
| Rate for Payer: HFN Commercial |
$1,393.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,136.25
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$909.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.80
|
| Rate for Payer: Quartz Beloit One Network |
$742.35
|
| Rate for Payer: Quartz Commercial |
$984.75
|
| Rate for Payer: Quartz Medicare Advantage |
$909.00
|
| Rate for Payer: The Alliance Commercial |
$6,060.00
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
CATH IAB SENSATION PLUS 50CC 0684-00-0576-01U
|
Facility
OP
|
$6,132.00
|
|
| Hospital Charge Code |
4594856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,716.96 |
| Max. Negotiated Rate |
$24,528.00 |
| Rate for Payer: Aetna Commercial |
$5,518.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,273.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,716.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,985.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,066.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,943.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,249.96
|
| Rate for Payer: Cash Price |
$1,839.60
|
| Rate for Payer: Cigna Commercial |
$5,641.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,431.47
|
| Rate for Payer: Health EOS Commercial |
$5,457.48
|
| Rate for Payer: HFN Commercial |
$5,641.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,599.00
|
| Rate for Payer: Multiplan Commercial |
$4,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,679.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,641.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,004.68
|
| Rate for Payer: Quartz Commercial |
$3,985.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,679.20
|
| Rate for Payer: The Alliance Commercial |
$24,528.00
|
| Rate for Payer: WEA Trust Commercial |
$3,372.60
|
| Rate for Payer: WPS Commercial |
$4,541.97
|
|
|
CATH IAB SENSATION PLUS 50CC 0684-00-0576-01U
|
Facility
IP
|
$6,132.00
|
|
| Hospital Charge Code |
4594856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,004.68 |
| Max. Negotiated Rate |
$5,641.44 |
| Rate for Payer: Aetna Commercial |
$5,518.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,249.96
|
| Rate for Payer: Cash Price |
$1,839.60
|
| Rate for Payer: Cigna Commercial |
$5,641.44
|
| Rate for Payer: Health EOS Commercial |
$5,457.48
|
| Rate for Payer: HFN Commercial |
$5,641.44
|
| Rate for Payer: Multiplan Commercial |
$4,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,679.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,641.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,004.68
|
| Rate for Payer: Quartz Commercial |
$3,679.20
|
| Rate for Payer: WEA Trust Commercial |
$3,372.60
|
| Rate for Payer: WPS Commercial |
$4,541.97
|
|
|
CATH INTUBATION AINTREE 19FX56CM C-CAE-19.0-56-AIC
|
Facility
OP
|
$1,246.00
|
|
| Hospital Charge Code |
4104320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.88 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna Commercial |
$1,121.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,071.56
|
| Rate for Payer: Aetna Managed Medicare |
$348.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$623.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$598.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.38
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cigna Commercial |
$1,146.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$697.26
|
| Rate for Payer: Health EOS Commercial |
$1,108.94
|
| Rate for Payer: HFN Commercial |
$1,146.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.50
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: NAPHCARE Commercial |
$747.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.32
|
| Rate for Payer: Quartz Beloit One Network |
$610.54
|
| Rate for Payer: Quartz Commercial |
$809.90
|
| Rate for Payer: Quartz Medicare Advantage |
$747.60
|
| Rate for Payer: The Alliance Commercial |
$4,984.00
|
| Rate for Payer: WEA Trust Commercial |
$685.30
|
| Rate for Payer: WPS Commercial |
$922.91
|
|
|
CATH INTUBATION AINTREE 19FX56CM C-CAE-19.0-56-AIC
|
Facility
IP
|
$1,246.00
|
|
| Hospital Charge Code |
4104320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.54 |
| Max. Negotiated Rate |
$1,146.32 |
| Rate for Payer: Aetna Commercial |
$1,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.38
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cigna Commercial |
$1,146.32
|
| Rate for Payer: Health EOS Commercial |
$1,108.94
|
| Rate for Payer: HFN Commercial |
$1,146.32
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: NAPHCARE Commercial |
$747.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.32
|
| Rate for Payer: Quartz Beloit One Network |
$610.54
|
| Rate for Payer: Quartz Commercial |
$747.60
|
| Rate for Payer: WEA Trust Commercial |
$685.30
|
| Rate for Payer: WPS Commercial |
$922.91
|
|
|
CATH KIT GLIDEPATH 19CM 5393190
|
Facility
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$13,400.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| Rate for Payer: Aetna Managed Medicare |
$938.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,177.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,874.66
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,512.50
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,177.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.00
|
| Rate for Payer: The Alliance Commercial |
$13,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 19CM 5393190
|
Facility
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.50 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,010.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 23CM 5393230
|
Facility
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.50 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,010.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 23CM 5393230
|
Facility
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$13,400.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| Rate for Payer: Aetna Managed Medicare |
$938.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,177.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,874.66
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,512.50
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,177.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.00
|
| Rate for Payer: The Alliance Commercial |
$13,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 27CM 5393270
|
Facility
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$13,400.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| Rate for Payer: Aetna Managed Medicare |
$938.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,177.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,874.66
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,512.50
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,177.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.00
|
| Rate for Payer: The Alliance Commercial |
$13,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 27CM 5393270
|
Facility
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.50 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,010.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 31CM 5393310
|
Facility
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.50 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,010.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 31CM 5393310
|
Facility
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$13,400.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| Rate for Payer: Aetna Managed Medicare |
$938.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,177.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,874.66
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,512.50
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,177.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.00
|
| Rate for Payer: The Alliance Commercial |
$13,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 50CM 5393500
|
Facility
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$13,400.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| Rate for Payer: Aetna Managed Medicare |
$938.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,177.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,874.66
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,512.50
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,177.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.00
|
| Rate for Payer: The Alliance Commercial |
$13,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
|
CATH KIT GLIDEPATH 50CM 5393500
|
Facility
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.50 |
| Max. Negotiated Rate |
$3,082.00 |
| Rate for Payer: Aetna Commercial |
$3,015.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,082.00
|
| Rate for Payer: Health EOS Commercial |
$2,981.50
|
| Rate for Payer: HFN Commercial |
$3,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.50
|
| Rate for Payer: Quartz Commercial |
$2,010.00
|
| Rate for Payer: WEA Trust Commercial |
$1,842.50
|
| Rate for Payer: WPS Commercial |
$2,481.34
|
|
