|
CATH STRAIGHT SELF CATH 12FR 12 28612"
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
4493864
|
|
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 STRAIGHT SELF CATH 12FR 12 28612"
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
4493864
|
|
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-Suction Tri-Flo 10Fr
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Cath-Suction Tri-Flo 10Fr
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Cath-Suction Tri-Flo 10Fr BCE
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
3101758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.36
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Cath-Suction Tri-Flo 10Fr BCE
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
3101758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Cath Supervalvular AO Root Angio +
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
3052503
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$6,784.00 |
| Rate for Payer: Aetna Commercial |
$1,526.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,458.56
|
| Rate for Payer: Aetna Managed Medicare |
$474.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,102.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.08
|
| 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
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.08
|
| Rate for Payer: Health EOS Commercial |
$1,509.44
|
| Rate for Payer: HFN Commercial |
$1,560.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.00
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.32
|
| Rate for Payer: Quartz Beloit One Network |
$831.04
|
| Rate for Payer: Quartz Commercial |
$1,102.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.60
|
| Rate for Payer: The Alliance Commercial |
$6,784.00
|
| Rate for Payer: WEA Trust Commercial |
$932.80
|
| Rate for Payer: WPS Commercial |
$1,256.23
|
|
|
Cath Supervalvular AO Root Angio +
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
3052503
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,458.56
|
| 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
|
| Rate for Payer: Health EOS Commercial |
$1,509.44
|
| Rate for Payer: HFN Commercial |
$1,560.32
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.32
|
| Rate for Payer: Quartz Beloit One Network |
$831.04
|
| Rate for Payer: Quartz Commercial |
$1,017.60
|
| Rate for Payer: WEA Trust Commercial |
$932.80
|
| Rate for Payer: WPS Commercial |
$1,256.23
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$878.92
|
| 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
|
|
|
CATH THERMODILUTION 4 LUMEN
|
Facility
|
OP
|
$1,022.00
|
|
| Hospital Charge Code |
2963083
|
|
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
|
| 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
|
| Rate for Payer: Health EOS Commercial |
$909.58
|
| Rate for Payer: HFN Commercial |
$940.24
|
| 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
|
| Rate for Payer: Preferred Network Access Commercial |
$940.24
|
| Rate for Payer: Quartz Beloit One Network |
$500.78
|
| 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
|
| Rate for Payer: WPS Commercial |
$757.00
|
|
|
CATH THERMODILUTION 5 LUMEN 41233-01
|
Facility
|
IP
|
$985.00
|
|
| Hospital Charge Code |
2963084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.65 |
| Max. Negotiated Rate |
$906.20 |
| Rate for Payer: Aetna Commercial |
$886.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$906.20
|
| Rate for Payer: Health EOS Commercial |
$876.65
|
| Rate for Payer: HFN Commercial |
$906.20
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.00
|
| Rate for Payer: Preferred Network Access Commercial |
$906.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.65
|
| Rate for Payer: Quartz Commercial |
$591.00
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$729.59
|
|
|
CATH THERMODILUTION 5 LUMEN 41233-01
|
Facility
|
OP
|
$985.00
|
|
| Hospital Charge Code |
2963084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$3,940.00 |
| Rate for Payer: Aetna Commercial |
$886.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.10
|
| Rate for Payer: Aetna Managed Medicare |
$275.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$492.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$906.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.21
|
| Rate for Payer: Health EOS Commercial |
$876.65
|
| Rate for Payer: HFN Commercial |
$906.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$738.75
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.00
|
| Rate for Payer: Preferred Network Access Commercial |
$906.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.65
|
| Rate for Payer: Quartz Commercial |
$640.25
|
| Rate for Payer: Quartz Medicare Advantage |
$591.00
|
| Rate for Payer: The Alliance Commercial |
$3,940.00
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$729.59
|
|
|
CATH THORACIC 12FR 8012
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
4998737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THORACIC 12FR 8012
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
4998737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THORACIC 8FR 8008
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THORACIC 8FR 8008
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THROMBECTOMY SYNTEL FOGARTY 4F X 50CM A4545
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
6207018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.64 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Aetna Managed Medicare |
$493.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,145.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$881.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$846.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$986.57
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.25
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,145.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.80
|
| Rate for Payer: The Alliance Commercial |
$7,052.00
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
CATH THROMBECTOMY SYNTEL FOGARTY 4F X 50CM A4545
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
6207018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$863.87 |
| Max. Negotiated Rate |
$1,621.96 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,057.80
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
|
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.84 |
| Max. Negotiated Rate |
$2,038.72 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,329.60
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
|
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.48 |
| Max. Negotiated Rate |
$8,864.00 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.76
|
| Rate for Payer: Aetna Managed Medicare |
$620.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,440.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.07
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.00
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,440.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.60
|
| Rate for Payer: The Alliance Commercial |
$8,864.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
|
IP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.35 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,269.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
|
OP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.20 |
| Max. Negotiated Rate |
$8,460.00 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Aetna Managed Medicare |
$592.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.55
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.00
|
| Rate for Payer: The Alliance Commercial |
$8,460.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
CATH TRAY MAHURKAR STR 12FR X 13.0 8888221313
|
Facility
|
IP
|
$2,198.00
|
|
| Hospital Charge Code |
2963063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.02 |
| Max. Negotiated Rate |
$2,022.16 |
| Rate for Payer: Aetna Commercial |
$1,978.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.94
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,022.16
|
| Rate for Payer: Health EOS Commercial |
$1,956.22
|
| Rate for Payer: HFN Commercial |
$2,022.16
|
| Rate for Payer: Multiplan Commercial |
$1,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,318.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.02
|
| Rate for Payer: Quartz Commercial |
$1,318.80
|
| Rate for Payer: WEA Trust Commercial |
$1,208.90
|
| Rate for Payer: WPS Commercial |
$1,628.06
|
|
|
CATH TRAY MAHURKAR STR 12FR X 13.0 8888221313
|
Facility
|
OP
|
$2,198.00
|
|
| Hospital Charge Code |
2963063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.44 |
| Max. Negotiated Rate |
$8,792.00 |
| Rate for Payer: Aetna Commercial |
$1,978.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.28
|
| Rate for Payer: Aetna Managed Medicare |
$615.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,428.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.94
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,022.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.00
|
| Rate for Payer: Health EOS Commercial |
$1,956.22
|
| Rate for Payer: HFN Commercial |
$2,022.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,648.50
|
| Rate for Payer: Multiplan Commercial |
$1,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,318.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.02
|
| Rate for Payer: Quartz Commercial |
$1,428.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,318.80
|
| Rate for Payer: The Alliance Commercial |
$8,792.00
|
| Rate for Payer: WEA Trust Commercial |
$1,208.90
|
| Rate for Payer: WPS Commercial |
$1,628.06
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
|
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.84 |
| Max. Negotiated Rate |
$2,038.72 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,329.60
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
