|
CATH KIT PALINDROME 19CM 8888145057P
|
Facility
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,342.69 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 19CM 8888145057P
|
Facility
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.68 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.75
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$3,107.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 23CM 8888145048P
|
Facility
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.68 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.75
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$3,107.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 23CM 8888145048P
|
Facility
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,342.69 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 28CM 8888145049P
|
Facility
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.68 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.75
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$3,107.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 28CM 8888145049P
|
Facility
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,342.69 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 33CM 8888145050P
|
Facility
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.68 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.75
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$3,107.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 33CM 8888145050P
|
Facility
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,342.69 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 55CM 8888145066P
|
Facility
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.69 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH KIT PALINDROME 55CM 8888145066P
|
Facility
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.68 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.75
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$3,107.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CATH.MENTOR SELF-CATH
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
CATH.MENTOR SELF-CATH
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
CATH PLCMT COR ART, ANGIO, INC INTRA INJ 93454
|
Professional
|
$4,807.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3015389
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$625.75 |
| Max. Negotiated Rate |
$4,566.65 |
| Rate for Payer: Aetna Commercial |
$4,566.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,134.02
|
| Rate for Payer: Aetna Managed Medicare |
$861.69
|
| Rate for Payer: Anthem Medicare Advantage |
$861.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$861.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$861.69
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cigna Commercial |
$4,566.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.69
|
| Rate for Payer: Health EOS Commercial |
$4,374.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,233.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,233.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$861.69
|
| Rate for Payer: Multiplan Commercial |
$3,845.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,566.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,115.08
|
| Rate for Payer: Quartz Commercial |
$2,739.99
|
| Rate for Payer: Quartz Medicare Advantage |
$861.69
|
| Rate for Payer: The Alliance Commercial |
$3,274.42
|
| Rate for Payer: United Healthcare Medicaid |
$625.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$861.69
|
| Rate for Payer: WEA Trust Commercial |
$2,643.85
|
| Rate for Payer: WPS Commercial |
$3,446.76
|
|
|
CATH PLCMT COR ART, ANGIO, INC INTRA INJ 9345422
|
Professional
|
$5,768.00
|
|
|
Service Code
|
CPT 93454 22
|
| Hospital Charge Code |
5278617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,537.92 |
| Max. Negotiated Rate |
$5,479.60 |
| Rate for Payer: Aetna Commercial |
$5,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,479.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,884.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,460.80
|
| Rate for Payer: Health EOS Commercial |
$5,248.88
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,479.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,537.92
|
| Rate for Payer: Quartz Commercial |
$3,287.76
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
CATH PLCMT COR ART, ANGIO, INC INTRA INJ 9345426
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Professional
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$4,807.00
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Service Code
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CPT 93454 26
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| Hospital Charge Code |
3015390
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Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$212.90 |
| Max. Negotiated Rate |
$4,566.65 |
| Rate for Payer: Aetna Commercial |
$4,566.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,134.02
|
| Rate for Payer: Aetna Managed Medicare |
$212.90
|
| Rate for Payer: Anthem Medicare Advantage |
$212.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$212.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$212.90
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| Rate for Payer: Cash Price |
$1,442.10
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| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cigna Commercial |
$4,566.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,403.50
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| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.90
|
| Rate for Payer: Health EOS Commercial |
$4,374.37
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| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.31
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| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$774.31
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| Rate for Payer: Independent Care Health Plan Medicare |
$212.90
|
| Rate for Payer: Multiplan Commercial |
$3,845.60
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| Rate for Payer: Preferred Network Access Commercial |
$4,566.65
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| Rate for Payer: Quartz Beloit One Network |
$2,115.08
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| Rate for Payer: Quartz Commercial |
$2,739.99
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| Rate for Payer: Quartz Medicare Advantage |
$212.90
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| Rate for Payer: The Alliance Commercial |
$809.02
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| Rate for Payer: United Healthcare Medicare Advantage |
$212.90
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| Rate for Payer: WEA Trust Commercial |
$2,643.85
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| Rate for Payer: WPS Commercial |
$851.60
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CATH STRAIGHT SELF CATH 12FR 12 28612"
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Facility
OP
|
$89.00
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|
| Hospital Charge Code |
4493864
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Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
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| Rate for Payer: Aetna Managed Medicare |
$24.92
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| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
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| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
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| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
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| Rate for Payer: Cash Price |
$26.70
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| Rate for Payer: Cigna Commercial |
$81.88
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| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
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| Rate for Payer: Health EOS Commercial |
$79.21
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| Rate for Payer: HFN Commercial |
$81.88
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| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
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| Rate for Payer: Multiplan Commercial |
$71.20
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| Rate for Payer: NAPHCARE Commercial |
$53.40
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| Rate for Payer: Preferred Network Access Commercial |
$81.88
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| Rate for Payer: Quartz Beloit One Network |
$43.61
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| Rate for Payer: Quartz Commercial |
$57.85
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| Rate for Payer: Quartz Medicare Advantage |
$53.40
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| Rate for Payer: The Alliance Commercial |
$356.00
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| Rate for Payer: WEA Trust Commercial |
$48.95
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| Rate for Payer: WPS Commercial |
$65.92
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CATH STRAIGHT SELF CATH 12FR 12 28612"
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Facility
IP
|
$89.00
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|
| Hospital Charge Code |
4493864
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|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
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| Rate for Payer: Cash Price |
$26.70
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| Rate for Payer: Cigna Commercial |
$81.88
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| Rate for Payer: Health EOS Commercial |
$79.21
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| Rate for Payer: HFN Commercial |
$81.88
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| Rate for Payer: Multiplan Commercial |
$71.20
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| Rate for Payer: NAPHCARE Commercial |
$53.40
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| Rate for Payer: Preferred Network Access Commercial |
$81.88
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| Rate for Payer: Quartz Beloit One Network |
$43.61
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| Rate for Payer: Quartz Commercial |
$53.40
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| Rate for Payer: WEA Trust Commercial |
$48.95
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| Rate for Payer: WPS Commercial |
$65.92
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Cath-Suction Tri-Flo 10Fr
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Facility
OP
|
$1.00
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| Hospital Charge Code |
3040351
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Hospital Revenue Code
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271
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| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
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| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
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| Rate for Payer: Aetna Managed Medicare |
$0.28
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| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
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| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
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| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
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| Rate for Payer: Cash Price |
$0.30
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| Rate for Payer: Cigna Commercial |
$0.92
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| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
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| Rate for Payer: Health EOS Commercial |
$0.89
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| Rate for Payer: HFN Commercial |
$0.92
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| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
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| Rate for Payer: Multiplan Commercial |
$0.80
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| Rate for Payer: NAPHCARE Commercial |
$0.60
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| Rate for Payer: Preferred Network Access Commercial |
$0.92
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| Rate for Payer: Quartz Beloit One Network |
$0.49
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| Rate for Payer: Quartz Commercial |
$0.65
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| Rate for Payer: Quartz Medicare Advantage |
$0.60
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| Rate for Payer: The Alliance Commercial |
$4.00
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| Rate for Payer: WEA Trust Commercial |
$0.55
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| Rate for Payer: WPS Commercial |
$0.74
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Cath-Suction Tri-Flo 10Fr
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Facility
IP
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$1.00
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| Hospital Charge Code |
3040351
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Hospital Revenue Code
|
271
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| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
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| Rate for Payer: Cash Price |
$0.30
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| Rate for Payer: Cigna Commercial |
$0.92
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| Rate for Payer: Health EOS Commercial |
$0.89
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| Rate for Payer: HFN Commercial |
$0.92
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| Rate for Payer: Multiplan Commercial |
$0.80
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| Rate for Payer: NAPHCARE Commercial |
$0.60
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| Rate for Payer: Preferred Network Access Commercial |
$0.92
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| Rate for Payer: Quartz Beloit One Network |
$0.49
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| Rate for Payer: Quartz Commercial |
$0.60
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| Rate for Payer: WEA Trust Commercial |
$0.55
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| Rate for Payer: WPS Commercial |
$0.74
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Cath-Suction Tri-Flo 10Fr BCE
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Facility
OP
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$6.00
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| Hospital Charge Code |
3101758
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Hospital Revenue Code
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271
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| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
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| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
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| Rate for Payer: Aetna Managed Medicare |
$1.68
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| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
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| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
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| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
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| Rate for Payer: Cash Price |
$1.80
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| Rate for Payer: Cigna Commercial |
$5.52
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| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.36
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| Rate for Payer: Health EOS Commercial |
$5.34
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| Rate for Payer: HFN Commercial |
$5.52
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| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
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| Rate for Payer: Multiplan Commercial |
$4.80
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| Rate for Payer: NAPHCARE Commercial |
$3.60
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| Rate for Payer: Preferred Network Access Commercial |
$5.52
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| Rate for Payer: Quartz Beloit One Network |
$2.94
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| Rate for Payer: Quartz Commercial |
$3.90
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| Rate for Payer: Quartz Medicare Advantage |
$3.60
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| Rate for Payer: The Alliance Commercial |
$24.00
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| Rate for Payer: WEA Trust Commercial |
$3.30
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| Rate for Payer: WPS Commercial |
$4.44
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Cath-Suction Tri-Flo 10Fr BCE
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Facility
IP
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$6.00
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| Hospital Charge Code |
3101758
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|
Hospital Revenue Code
|
271
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| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
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| Rate for Payer: Cash Price |
$1.80
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| Rate for Payer: Cigna Commercial |
$5.52
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| Rate for Payer: Health EOS Commercial |
$5.34
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| Rate for Payer: HFN Commercial |
$5.52
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| Rate for Payer: Multiplan Commercial |
$4.80
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| Rate for Payer: NAPHCARE Commercial |
$3.60
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| Rate for Payer: Preferred Network Access Commercial |
$5.52
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| Rate for Payer: Quartz Beloit One Network |
$2.94
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| Rate for Payer: Quartz Commercial |
$3.60
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| Rate for Payer: WEA Trust Commercial |
$3.30
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| Rate for Payer: WPS Commercial |
$4.44
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Cath Supervalvular AO Root Angio +
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Facility
OP
|
$1,696.00
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Service Code
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CPT 93567
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| Hospital Charge Code |
3052503
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Hospital Revenue Code
|
481
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| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$1,560.32 |
| Rate for Payer: Aetna Commercial |
$1,526.40
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| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,458.56
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| Rate for Payer: Aetna Managed Medicare |
$474.88
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| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,102.40
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| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.00
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| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.08
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| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.88
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| Rate for Payer: Cash Price |
$508.80
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| Rate for Payer: Cash Price |
$508.80
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| Rate for Payer: Cigna Commercial |
$1,560.32
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| Rate for Payer: Health EOS Commercial |
$1,509.44
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| Rate for Payer: HFN Commercial |
$1,560.32
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| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.00
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| Rate for Payer: Multiplan Commercial |
$1,356.80
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| Rate for Payer: NAPHCARE Commercial |
$1,017.60
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| Rate for Payer: Preferred Network Access Commercial |
$1,560.32
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| Rate for Payer: Quartz Beloit One Network |
$831.04
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| Rate for Payer: Quartz Commercial |
$1,102.40
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| Rate for Payer: Quartz Medicare Advantage |
$1,017.60
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| Rate for Payer: WEA Trust Commercial |
$932.80
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| Rate for Payer: WPS Commercial |
$1,256.23
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Cath Supervalvular AO Root Angio +
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Facility
IP
|
$1,696.00
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|
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Service Code
|
CPT 93567
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| Hospital Charge Code |
3052503
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|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$831.04 |
| Max. Negotiated Rate |
$1,560.32 |
| Rate for Payer: Aetna Commercial |
$1,526.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.88
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,560.32
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| Rate for Payer: Health EOS Commercial |
$1,509.44
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| Rate for Payer: HFN Commercial |
$1,560.32
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| Rate for Payer: Multiplan Commercial |
$1,356.80
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| Rate for Payer: NAPHCARE Commercial |
$1,017.60
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| Rate for Payer: Preferred Network Access Commercial |
$1,560.32
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| Rate for Payer: Quartz Beloit One Network |
$831.04
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| Rate for Payer: Quartz Commercial |
$1,017.60
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| Rate for Payer: WEA Trust Commercial |
$932.80
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| Rate for Payer: WPS Commercial |
$1,256.23
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CATH THERMODILUTION 4 LUMEN
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Facility
OP
|
$1,022.00
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| Hospital Charge Code |
2963083
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Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.16 |
| Max. Negotiated Rate |
$4,088.00 |
| Rate for Payer: Aetna Commercial |
$919.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.92
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| Rate for Payer: Aetna Managed Medicare |
$286.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.66
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$940.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.91
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| Rate for Payer: Health EOS Commercial |
$909.58
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| Rate for Payer: HFN Commercial |
$940.24
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| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$817.60
|
| Rate for Payer: NAPHCARE Commercial |
$613.20
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| Rate for Payer: Preferred Network Access Commercial |
$940.24
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| Rate for Payer: Quartz Beloit One Network |
$500.78
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| Rate for Payer: Quartz Commercial |
$664.30
|
| Rate for Payer: Quartz Medicare Advantage |
$613.20
|
| Rate for Payer: The Alliance Commercial |
$4,088.00
|
| Rate for Payer: WEA Trust Commercial |
$562.10
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| Rate for Payer: WPS Commercial |
$757.00
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CATH THERMODILUTION 4 LUMEN
|
Facility
IP
|
$1,022.00
|
|
| Hospital Charge Code |
2963083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.78 |
| Max. Negotiated Rate |
$940.24 |
| Rate for Payer: Aetna Commercial |
$919.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.66
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$940.24
|
| Rate for Payer: Health EOS Commercial |
$909.58
|
| Rate for Payer: HFN Commercial |
$940.24
|
| Rate for Payer: Multiplan Commercial |
$817.60
|
| Rate for Payer: NAPHCARE Commercial |
$613.20
|
| Rate for Payer: Preferred Network Access Commercial |
$940.24
|
| Rate for Payer: Quartz Beloit One Network |
$500.78
|
| Rate for Payer: Quartz Commercial |
$613.20
|
| Rate for Payer: WEA Trust Commercial |
$562.10
|
| Rate for Payer: WPS Commercial |
$757.00
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