|
CATH GARD SHIELD 8 & 8.5 FR
|
Facility
|
OP
|
$274.00
|
|
| Hospital Charge Code |
2962950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
CATH GARD SHIELD 8 & 8.5 FR
|
Facility
|
IP
|
$274.00
|
|
| Hospital Charge Code |
2962950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
CATH HICKMAN 8F SINGLE LUMEN
|
Facility
|
IP
|
$1,244.00
|
|
| Hospital Charge Code |
2963170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.94 |
| Max. Negotiated Rate |
$1,190.26 |
| Rate for Payer: Aetna Commercial |
$1,164.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.69
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,190.26
|
| Rate for Payer: Health EOS Commercial |
$1,151.45
|
| Rate for Payer: HFN Commercial |
$1,190.26
|
| Rate for Payer: Multiplan Commercial |
$1,035.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.26
|
| Rate for Payer: Quartz Beloit One Network |
$633.94
|
| Rate for Payer: Quartz Commercial |
$776.26
|
| Rate for Payer: WEA Trust Commercial |
$711.57
|
| Rate for Payer: WPS Commercial |
$958.25
|
|
|
CATH HICKMAN 8F SINGLE LUMEN
|
Facility
|
OP
|
$1,244.00
|
|
| Hospital Charge Code |
2963170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$1,190.26 |
| Rate for Payer: Aetna Commercial |
$1,164.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.63
|
| Rate for Payer: Aetna Managed Medicare |
$362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$840.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.69
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,190.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.01
|
| Rate for Payer: Health EOS Commercial |
$1,151.45
|
| Rate for Payer: HFN Commercial |
$1,190.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$1,035.01
|
| Rate for Payer: NAPHCARE Commercial |
$776.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.26
|
| Rate for Payer: Quartz Beloit One Network |
$633.94
|
| Rate for Payer: Quartz Commercial |
$840.94
|
| Rate for Payer: Quartz Medicare Advantage |
$776.26
|
| Rate for Payer: The Alliance Commercial |
$646.88
|
| Rate for Payer: WEA Trust Commercial |
$711.57
|
| Rate for Payer: WPS Commercial |
$958.25
|
|
|
CATH IAB SENSATION PLUS 40CC 0684-00-0568-01U
|
Facility
|
IP
|
$1,515.00
|
|
| Hospital Charge Code |
4594855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.04 |
| Max. Negotiated Rate |
$1,449.55 |
| Rate for Payer: Aetna Commercial |
$1,418.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.07
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,449.55
|
| Rate for Payer: Health EOS Commercial |
$1,402.28
|
| Rate for Payer: HFN Commercial |
$1,449.55
|
| Rate for Payer: Multiplan Commercial |
$1,260.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.55
|
| Rate for Payer: Quartz Beloit One Network |
$772.04
|
| Rate for Payer: Quartz Commercial |
$945.36
|
| Rate for Payer: WEA Trust Commercial |
$866.58
|
| Rate for Payer: WPS Commercial |
$1,167.00
|
|
|
CATH IAB SENSATION PLUS 40CC 0684-00-0568-01U
|
Facility
|
OP
|
$1,515.00
|
|
| Hospital Charge Code |
4594855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.17 |
| Max. Negotiated Rate |
$1,449.55 |
| Rate for Payer: Aetna Commercial |
$1,418.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.02
|
| Rate for Payer: Aetna Managed Medicare |
$441.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,024.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.07
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,449.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.73
|
| Rate for Payer: Health EOS Commercial |
$1,402.28
|
| Rate for Payer: HFN Commercial |
$1,449.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.70
|
| Rate for Payer: Multiplan Commercial |
$1,260.48
|
| Rate for Payer: NAPHCARE Commercial |
$945.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.55
|
| Rate for Payer: Quartz Beloit One Network |
$772.04
|
| Rate for Payer: Quartz Commercial |
$1,024.14
|
| Rate for Payer: Quartz Medicare Advantage |
$945.36
|
| Rate for Payer: The Alliance Commercial |
$787.80
|
| Rate for Payer: WEA Trust Commercial |
$866.58
|
| Rate for Payer: WPS Commercial |
$1,167.00
|
|
|
CATH IAB SENSATION PLUS 50CC 0684-00-0576-01U
|
Facility
|
IP
|
$6,132.00
|
|
| Hospital Charge Code |
4594856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,124.87 |
| Max. Negotiated Rate |
$5,867.10 |
| Rate for Payer: Aetna Commercial |
$5,739.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,484.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,379.96
|
| Rate for Payer: Cash Price |
$1,839.60
|
| Rate for Payer: Cigna Commercial |
$5,867.10
|
| Rate for Payer: Health EOS Commercial |
$5,675.78
|
| Rate for Payer: HFN Commercial |
$5,867.10
|
| Rate for Payer: Multiplan Commercial |
$5,101.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,867.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,124.87
|
| Rate for Payer: Quartz Commercial |
$3,826.37
|
| Rate for Payer: WEA Trust Commercial |
$3,507.50
|
| Rate for Payer: WPS Commercial |
$4,723.48
|
|
|
CATH IAB SENSATION PLUS 50CC 0684-00-0576-01U
|
Facility
|
OP
|
$6,132.00
|
|
| Hospital Charge Code |
4594856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,785.64 |
| Max. Negotiated Rate |
$5,867.10 |
| Rate for Payer: Aetna Commercial |
$5,739.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,484.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,785.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,145.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,188.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,061.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,379.96
|
| Rate for Payer: Cash Price |
$1,839.60
|
| Rate for Payer: Cigna Commercial |
$5,867.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,568.82
|
| Rate for Payer: Health EOS Commercial |
$5,675.78
|
| Rate for Payer: HFN Commercial |
$5,867.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,782.96
|
| Rate for Payer: Multiplan Commercial |
$5,101.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,826.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,867.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,124.87
|
| Rate for Payer: Quartz Commercial |
$4,145.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,826.37
|
| Rate for Payer: The Alliance Commercial |
$3,188.64
|
| Rate for Payer: WEA Trust Commercial |
$3,507.50
|
| Rate for Payer: WPS Commercial |
$4,723.48
|
|
|
CATH INTUBATION AINTREE 19FX56CM C-CAE-19.0-56-AIC
|
Facility
|
IP
|
$1,246.00
|
|
| Hospital Charge Code |
4104320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$634.96 |
| Max. Negotiated Rate |
$1,192.17 |
| Rate for Payer: Aetna Commercial |
$1,166.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,114.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cigna Commercial |
$1,192.17
|
| Rate for Payer: Health EOS Commercial |
$1,153.30
|
| Rate for Payer: HFN Commercial |
$1,192.17
|
| Rate for Payer: Multiplan Commercial |
$1,036.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.17
|
| Rate for Payer: Quartz Beloit One Network |
$634.96
|
| Rate for Payer: Quartz Commercial |
$777.50
|
| Rate for Payer: WEA Trust Commercial |
$712.71
|
| Rate for Payer: WPS Commercial |
$959.79
|
|
|
CATH INTUBATION AINTREE 19FX56CM C-CAE-19.0-56-AIC
|
Facility
|
OP
|
$1,246.00
|
|
| Hospital Charge Code |
4104320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.84 |
| Max. Negotiated Rate |
$1,192.17 |
| Rate for Payer: Aetna Commercial |
$1,166.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,114.42
|
| Rate for Payer: Aetna Managed Medicare |
$362.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$842.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$647.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$622.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cigna Commercial |
$1,192.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$725.17
|
| Rate for Payer: Health EOS Commercial |
$1,153.30
|
| Rate for Payer: HFN Commercial |
$1,192.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$971.88
|
| Rate for Payer: Multiplan Commercial |
$1,036.67
|
| Rate for Payer: NAPHCARE Commercial |
$777.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.17
|
| Rate for Payer: Quartz Beloit One Network |
$634.96
|
| Rate for Payer: Quartz Commercial |
$842.30
|
| Rate for Payer: Quartz Medicare Advantage |
$777.50
|
| Rate for Payer: The Alliance Commercial |
$647.92
|
| Rate for Payer: WEA Trust Commercial |
$712.71
|
| Rate for Payer: WPS Commercial |
$959.79
|
|
|
CATH KIT GLIDEPATH 19CM 5393190
|
Facility
|
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Aetna Managed Medicare |
$975.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,264.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,672.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.70
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,090.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,264.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,090.40
|
| Rate for Payer: The Alliance Commercial |
$1,742.00
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 19CM 5393190
|
Facility
|
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.16 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,090.40
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 23CM 5393230
|
Facility
|
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Aetna Managed Medicare |
$975.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,264.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,672.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.70
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,090.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,264.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,090.40
|
| Rate for Payer: The Alliance Commercial |
$1,742.00
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 23CM 5393230
|
Facility
|
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.16 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,090.40
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 27CM 5393270
|
Facility
|
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.16 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,090.40
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 27CM 5393270
|
Facility
|
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Aetna Managed Medicare |
$975.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,264.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,672.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.70
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,090.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,264.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,090.40
|
| Rate for Payer: The Alliance Commercial |
$1,742.00
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 31CM 5393310
|
Facility
|
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.16 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,090.40
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 31CM 5393310
|
Facility
|
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Aetna Managed Medicare |
$975.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,264.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,672.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.70
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,090.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,264.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,090.40
|
| Rate for Payer: The Alliance Commercial |
$1,742.00
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 50CM 5393500
|
Facility
|
OP
|
$3,350.00
|
|
| Hospital Charge Code |
4641063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Aetna Managed Medicare |
$975.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,264.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,672.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.70
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,090.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,264.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,090.40
|
| Rate for Payer: The Alliance Commercial |
$1,742.00
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
CATH KIT GLIDEPATH 50CM 5393500
|
Facility
|
IP
|
$3,350.00
|
|
| Hospital Charge Code |
4641063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.16 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,090.40
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
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 |
$2,436.40 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$2,983.34
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
|
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 |
$1,392.23 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,392.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,231.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,486.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,386.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,782.54
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,729.18
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,983.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$3,231.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,983.34
|
| Rate for Payer: The Alliance Commercial |
$2,486.12
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
|
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 |
$2,436.40 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$2,983.34
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
|
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 |
$1,392.23 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,392.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,231.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,486.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,386.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,782.54
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,729.18
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,983.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$3,231.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,983.34
|
| Rate for Payer: The Alliance Commercial |
$2,486.12
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
|
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 |
$2,436.40 |
| Max. Negotiated Rate |
$4,574.46 |
| Rate for Payer: Aetna Commercial |
$4,475.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,276.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,635.29
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,574.46
|
| Rate for Payer: Health EOS Commercial |
$4,425.29
|
| Rate for Payer: HFN Commercial |
$4,574.46
|
| Rate for Payer: Multiplan Commercial |
$3,977.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,574.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,436.40
|
| Rate for Payer: Quartz Commercial |
$2,983.34
|
| Rate for Payer: WEA Trust Commercial |
$2,734.73
|
| Rate for Payer: WPS Commercial |
$3,682.80
|
|
