|
CATHETER INSERTION, SUPRAPUBIC
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CATHETER INSERTION, SWAN GANZ
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959918
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CATHETER INSERTION, SWAN GANZ
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959918
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CATHETER INTRAUTERINE PRESSURE IPC-5000E
|
Facility
|
OP
|
$658.00
|
|
| Hospital Charge Code |
2962962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Aetna Managed Medicare |
$191.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.96
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$513.24
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: NAPHCARE Commercial |
$410.59
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$444.81
|
| Rate for Payer: Quartz Medicare Advantage |
$410.59
|
| Rate for Payer: The Alliance Commercial |
$342.16
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
|
CATHETER INTRAUTERINE PRESSURE IPC-5000E
|
Facility
|
IP
|
$658.00
|
|
| Hospital Charge Code |
2962962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.32 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$410.59
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
|
CATHETER IV RADIAL ARTERY 20GA RA-04020
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
2962925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$64.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.94
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$139.15
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$139.15
|
| Rate for Payer: The Alliance Commercial |
$115.96
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
CATHETER IV RADIAL ARTERY 20GA RA-04020
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
2962925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
CATHETER IV RADIAL ARTERY SET
|
Facility
|
OP
|
$809.00
|
|
| Hospital Charge Code |
2974566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.58 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna Commercial |
$757.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Aetna Managed Medicare |
$235.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.92
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$774.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.84
|
| Rate for Payer: Health EOS Commercial |
$748.81
|
| Rate for Payer: HFN Commercial |
$774.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$631.02
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: NAPHCARE Commercial |
$504.82
|
| Rate for Payer: Preferred Network Access Commercial |
$774.05
|
| Rate for Payer: Quartz Beloit One Network |
$412.27
|
| Rate for Payer: Quartz Commercial |
$546.88
|
| Rate for Payer: Quartz Medicare Advantage |
$504.82
|
| Rate for Payer: The Alliance Commercial |
$420.68
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
CATHETER IV RADIAL ARTERY SET
|
Facility
|
IP
|
$809.00
|
|
| Hospital Charge Code |
2974566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.27 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna Commercial |
$757.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.92
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$774.05
|
| Rate for Payer: Health EOS Commercial |
$748.81
|
| Rate for Payer: HFN Commercial |
$774.05
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: Preferred Network Access Commercial |
$774.05
|
| Rate for Payer: Quartz Beloit One Network |
$412.27
|
| Rate for Payer: Quartz Commercial |
$504.82
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
CATHETERIZATION KIT ARTERIAL NS-04100-S
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
2969902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.46 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$183.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.66
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$393.12
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$425.88
|
| Rate for Payer: Quartz Medicare Advantage |
$393.12
|
| Rate for Payer: The Alliance Commercial |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
CATHETERIZATION KIT ARTERIAL NS-04100-S
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
2969902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$393.12
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
|
OP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,310.05 |
| Max. Negotiated Rate |
$14,161.60 |
| Rate for Payer: Aetna Commercial |
$13,853.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,238.01
|
| Rate for Payer: Aetna Managed Medicare |
$4,310.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,005.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,696.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,388.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,158.31
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$14,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,614.18
|
| Rate for Payer: Health EOS Commercial |
$13,699.81
|
| Rate for Payer: HFN Commercial |
$14,161.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,544.78
|
| Rate for Payer: Multiplan Commercial |
$12,314.43
|
| Rate for Payer: NAPHCARE Commercial |
$9,235.82
|
| Rate for Payer: Preferred Network Access Commercial |
$14,161.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,542.59
|
| Rate for Payer: Quartz Commercial |
$10,005.48
|
| Rate for Payer: Quartz Medicare Advantage |
$9,235.82
|
| Rate for Payer: The Alliance Commercial |
$7,696.52
|
| Rate for Payer: WEA Trust Commercial |
$8,466.17
|
| Rate for Payer: WPS Commercial |
$11,401.21
|
|
|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
|
IP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,542.59 |
| Max. Negotiated Rate |
$14,161.60 |
| Rate for Payer: Aetna Commercial |
$13,853.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,238.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,158.31
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$14,161.60
|
| Rate for Payer: Health EOS Commercial |
$13,699.81
|
| Rate for Payer: HFN Commercial |
$14,161.60
|
| Rate for Payer: Multiplan Commercial |
$12,314.43
|
| Rate for Payer: Preferred Network Access Commercial |
$14,161.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,542.59
|
| Rate for Payer: Quartz Commercial |
$9,235.82
|
| Rate for Payer: WEA Trust Commercial |
$8,466.17
|
| Rate for Payer: WPS Commercial |
$11,401.21
|
|
|
CATHETER JETSTREAM G3SF 1.6
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,040.94 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Aetna Managed Medicare |
$6,040.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,023.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,787.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,355.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,073.59
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,181.10
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,944.88
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$14,023.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12,944.88
|
| Rate for Payer: The Alliance Commercial |
$10,787.40
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM G3SF 1.6
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,571.65 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$12,944.88
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM G3SF 1.85
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,040.94 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Aetna Managed Medicare |
$6,040.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,023.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,787.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,355.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,073.59
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,181.10
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,944.88
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$14,023.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12,944.88
|
| Rate for Payer: The Alliance Commercial |
$10,787.40
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM G3SF 1.85
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,571.65 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$12,944.88
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM L
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,571.65 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$12,944.88
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM L
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,040.94 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Aetna Managed Medicare |
$6,040.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,023.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,787.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,355.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,073.59
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,181.10
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,944.88
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$14,023.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12,944.88
|
| Rate for Payer: The Alliance Commercial |
$10,787.40
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JL4 T 6FR 534620T
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2971393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER JL4 T 6FR 534620T
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2971393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER KIT FEMALE 8FR 0035720
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2963307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CATHETER KIT FEMALE 8FR 0035720
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2963307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CATHETER KUMAR CHOLANGIOGRAPHY CC-019
|
Facility
|
OP
|
$679.00
|
|
| Hospital Charge Code |
5178933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.72 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$635.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$459.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.26
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$649.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.18
|
| Rate for Payer: Health EOS Commercial |
$628.48
|
| Rate for Payer: HFN Commercial |
$649.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.62
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: NAPHCARE Commercial |
$423.70
|
| Rate for Payer: Preferred Network Access Commercial |
$649.67
|
| Rate for Payer: Quartz Beloit One Network |
$346.02
|
| Rate for Payer: Quartz Commercial |
$459.00
|
| Rate for Payer: Quartz Medicare Advantage |
$423.70
|
| Rate for Payer: The Alliance Commercial |
$353.08
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$523.03
|
|
|
CATHETER KUMAR CHOLANGIOGRAPHY CC-019
|
Facility
|
IP
|
$679.00
|
|
| Hospital Charge Code |
5178933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.02 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$635.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.26
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$649.67
|
| Rate for Payer: Health EOS Commercial |
$628.48
|
| Rate for Payer: HFN Commercial |
$649.67
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: Preferred Network Access Commercial |
$649.67
|
| Rate for Payer: Quartz Beloit One Network |
$346.02
|
| Rate for Payer: Quartz Commercial |
$423.70
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$523.03
|
|
