|
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 |
$1,392.23 |
| 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 33CM 8888145050P
|
Facility
|
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962851
|
|
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 33CM 8888145050P
|
Facility
|
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962851
|
|
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 55CM 8888145066P
|
Facility
|
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962854
|
|
Hospital Revenue Code
|
278
|
| 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 55CM 8888145066P
|
Facility
|
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
2962854
|
|
Hospital Revenue Code
|
278
|
| 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.MENTOR SELF-CATH
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
CATH.MENTOR SELF-CATH
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
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 |
$650.78 |
| Max. Negotiated Rate |
$4,749.32 |
| Rate for Payer: Aetna Commercial |
$4,749.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,299.38
|
| Rate for Payer: Aetna Managed Medicare |
$860.24
|
| Rate for Payer: Anthem Medicare Advantage |
$860.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$860.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$860.24
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cigna Commercial |
$4,749.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$650.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.24
|
| Rate for Payer: Health EOS Commercial |
$4,549.34
|
| Rate for Payer: HFN Commercial |
$4,749.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,362.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,362.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$860.24
|
| Rate for Payer: Multiplan Commercial |
$3,999.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,290.35
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,199.68
|
| Rate for Payer: Quartz Commercial |
$2,849.59
|
| Rate for Payer: Quartz Medicare Advantage |
$860.24
|
| Rate for Payer: The Alliance Commercial |
$3,268.90
|
| Rate for Payer: United Healthcare Medicaid |
$650.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$860.24
|
| Rate for Payer: WEA Trust Commercial |
$2,749.60
|
| Rate for Payer: WPS Commercial |
$3,440.94
|
|
|
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 |
$650.78 |
| Max. Negotiated Rate |
$5,698.78 |
| Rate for Payer: Aetna Commercial |
$5,698.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,158.90
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,698.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$650.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,599.23
|
| Rate for Payer: Health EOS Commercial |
$5,458.84
|
| Rate for Payer: HFN Commercial |
$5,698.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,362.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,362.60
|
| Rate for Payer: Multiplan Commercial |
$4,798.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.44
|
| Rate for Payer: Quartz Commercial |
$3,419.27
|
| Rate for Payer: The Alliance Commercial |
$2,999.36
|
| Rate for Payer: United Healthcare Medicaid |
$650.78
|
| Rate for Payer: WEA Trust Commercial |
$3,299.30
|
| Rate for Payer: WPS Commercial |
$4,443.09
|
|
|
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 |
$187.21 |
| Max. Negotiated Rate |
$4,749.32 |
| Rate for Payer: Aetna Commercial |
$4,749.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,299.38
|
| Rate for Payer: Aetna Managed Medicare |
$219.10
|
| Rate for Payer: Anthem Medicare Advantage |
$219.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.10
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cash Price |
$1,442.10
|
| Rate for Payer: Cigna Commercial |
$4,749.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.10
|
| Rate for Payer: Health EOS Commercial |
$4,549.34
|
| Rate for Payer: HFN Commercial |
$4,749.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$805.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$805.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.10
|
| Rate for Payer: Multiplan Commercial |
$3,999.42
|
| Rate for Payer: NAPHCARE Commercial |
$328.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,199.68
|
| Rate for Payer: Quartz Commercial |
$2,849.59
|
| Rate for Payer: Quartz Medicare Advantage |
$219.10
|
| Rate for Payer: The Alliance Commercial |
$832.57
|
| Rate for Payer: United Healthcare Medicaid |
$187.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.10
|
| Rate for Payer: WEA Trust Commercial |
$2,749.60
|
| Rate for Payer: WPS Commercial |
$876.39
|
|
|
CATH STRAIGHT SELF CATH 12FR 12 28612"
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
4493864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
CATH STRAIGHT SELF CATH 12FR 12 28612"
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
4493864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Cath-Suction Tri-Flo 10Fr
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cath-Suction Tri-Flo 10Fr
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cath-Suction Tri-Flo 10Fr BCE
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
3101758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Cath-Suction Tri-Flo 10Fr BCE
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
3101758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
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 |
$864.28 |
| Max. Negotiated Rate |
$1,622.73 |
| Rate for Payer: Aetna Commercial |
$1,587.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.84
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,622.73
|
| Rate for Payer: Health EOS Commercial |
$1,569.82
|
| Rate for Payer: HFN Commercial |
$1,622.73
|
| Rate for Payer: Multiplan Commercial |
$1,411.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.73
|
| Rate for Payer: Quartz Beloit One Network |
$864.28
|
| Rate for Payer: Quartz Commercial |
$1,058.30
|
| Rate for Payer: WEA Trust Commercial |
$970.11
|
| Rate for Payer: WPS Commercial |
$1,306.43
|
|
|
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 |
$118.64 |
| Max. Negotiated Rate |
$1,622.73 |
| Rate for Payer: Aetna Commercial |
$1,587.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.90
|
| Rate for Payer: Aetna Managed Medicare |
$493.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,146.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$881.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$846.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.84
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,622.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$987.07
|
| Rate for Payer: Health EOS Commercial |
$1,569.82
|
| Rate for Payer: HFN Commercial |
$1,622.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.88
|
| Rate for Payer: Multiplan Commercial |
$1,411.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,058.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.73
|
| Rate for Payer: Quartz Beloit One Network |
$864.28
|
| Rate for Payer: Quartz Commercial |
$1,146.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,058.30
|
| Rate for Payer: The Alliance Commercial |
$118.64
|
| Rate for Payer: WEA Trust Commercial |
$970.11
|
| Rate for Payer: WPS Commercial |
$1,306.43
|
|
|
CATH THERMODILUTION 4 LUMEN
|
Facility
|
IP
|
$1,022.00
|
|
| Hospital Charge Code |
2963083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.81 |
| Max. Negotiated Rate |
$977.85 |
| Rate for Payer: Aetna Commercial |
$956.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.33
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$977.85
|
| Rate for Payer: Health EOS Commercial |
$945.96
|
| Rate for Payer: HFN Commercial |
$977.85
|
| Rate for Payer: Multiplan Commercial |
$850.30
|
| Rate for Payer: Preferred Network Access Commercial |
$977.85
|
| Rate for Payer: Quartz Beloit One Network |
$520.81
|
| Rate for Payer: Quartz Commercial |
$637.73
|
| Rate for Payer: WEA Trust Commercial |
$584.58
|
| Rate for Payer: WPS Commercial |
$787.25
|
|
|
CATH THERMODILUTION 4 LUMEN
|
Facility
|
OP
|
$1,022.00
|
|
| Hospital Charge Code |
2963083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.61 |
| Max. Negotiated Rate |
$977.85 |
| Rate for Payer: Aetna Commercial |
$956.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.08
|
| Rate for Payer: Aetna Managed Medicare |
$297.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.33
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$977.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.80
|
| Rate for Payer: Health EOS Commercial |
$945.96
|
| Rate for Payer: HFN Commercial |
$977.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.16
|
| Rate for Payer: Multiplan Commercial |
$850.30
|
| Rate for Payer: NAPHCARE Commercial |
$637.73
|
| Rate for Payer: Preferred Network Access Commercial |
$977.85
|
| Rate for Payer: Quartz Beloit One Network |
$520.81
|
| Rate for Payer: Quartz Commercial |
$690.87
|
| Rate for Payer: Quartz Medicare Advantage |
$637.73
|
| Rate for Payer: The Alliance Commercial |
$531.44
|
| Rate for Payer: WEA Trust Commercial |
$584.58
|
| Rate for Payer: WPS Commercial |
$787.25
|
|
|
CATH THERMODILUTION 5 LUMEN 41233-01
|
Facility
|
IP
|
$985.00
|
|
| Hospital Charge Code |
2963084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.96 |
| Max. Negotiated Rate |
$942.45 |
| Rate for Payer: Aetna Commercial |
$921.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.93
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$942.45
|
| Rate for Payer: Health EOS Commercial |
$911.72
|
| Rate for Payer: HFN Commercial |
$942.45
|
| Rate for Payer: Multiplan Commercial |
$819.52
|
| Rate for Payer: Preferred Network Access Commercial |
$942.45
|
| Rate for Payer: Quartz Beloit One Network |
$501.96
|
| Rate for Payer: Quartz Commercial |
$614.64
|
| Rate for Payer: WEA Trust Commercial |
$563.42
|
| Rate for Payer: WPS Commercial |
$758.75
|
|
|
CATH THERMODILUTION 5 LUMEN 41233-01
|
Facility
|
OP
|
$985.00
|
|
| Hospital Charge Code |
2963084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.83 |
| Max. Negotiated Rate |
$942.45 |
| Rate for Payer: Aetna Commercial |
$921.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.98
|
| Rate for Payer: Aetna Managed Medicare |
$286.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$665.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.93
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$942.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.27
|
| Rate for Payer: Health EOS Commercial |
$911.72
|
| Rate for Payer: HFN Commercial |
$942.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.30
|
| Rate for Payer: Multiplan Commercial |
$819.52
|
| Rate for Payer: NAPHCARE Commercial |
$614.64
|
| Rate for Payer: Preferred Network Access Commercial |
$942.45
|
| Rate for Payer: Quartz Beloit One Network |
$501.96
|
| Rate for Payer: Quartz Commercial |
$665.86
|
| Rate for Payer: Quartz Medicare Advantage |
$614.64
|
| Rate for Payer: The Alliance Commercial |
$512.20
|
| Rate for Payer: WEA Trust Commercial |
$563.42
|
| Rate for Payer: WPS Commercial |
$758.75
|
|
|
CATH THORACIC 12FR 8012
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
4998737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CATH THORACIC 12FR 8012
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
4998737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CATH THORACIC 8FR 8008
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
