|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| 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 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,881.00
|
| 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 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 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 |
$19,124.00 |
| 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: The Alliance Commercial |
$19,124.00
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| 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 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 |
$19,124.00 |
| 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: The Alliance Commercial |
$19,124.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| 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 |
$19,124.00 |
| 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: The Alliance Commercial |
$19,124.00
|
| 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 |
$19,124.00 |
| 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: The Alliance Commercial |
$19,124.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| 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 |
$19,124.00 |
| 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: The Alliance Commercial |
$19,124.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| 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.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 |
$356.00 |
| 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: The Alliance Commercial |
$356.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| 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
|
Both
|
$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: 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 |
$625.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,884.20
|
| Rate for Payer: Health EOS Commercial |
$4,374.37
|
| Rate for Payer: HFN Commercial |
$4,566.65
|
| 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: 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: The Alliance Commercial |
$2,403.50
|
| Rate for Payer: United Healthcare Medicaid |
$625.75
|
| Rate for Payer: WEA Trust Commercial |
$2,643.85
|
| Rate for Payer: WPS Commercial |
$3,560.54
|
|
|
CATH PLCMT COR ART, ANGIO, INC INTRA INJ 9345422
|
Professional
|
Both
|
$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: HFN Commercial |
$5,479.60
|
| 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
|
Professional
|
Both
|
$4,807.00
|
|
|
Service Code
|
CPT 93454 26
|
| Hospital Charge Code |
3015390
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$774.31 |
| 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: 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 |
$2,884.20
|
| Rate for Payer: Health EOS Commercial |
$4,374.37
|
| Rate for Payer: HFN Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$774.31
|
| 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: The Alliance Commercial |
$2,403.50
|
| Rate for Payer: WEA Trust Commercial |
$2,643.85
|
| Rate for Payer: WPS Commercial |
$3,560.54
|
|
