|
CATHETER (VOLCANO) VISIONS PV MODEL 86700
|
Facility
|
OP
|
$3,973.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
3107480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.94 |
| Max. Negotiated Rate |
$3,801.37 |
| Rate for Payer: Aetna Commercial |
$3,718.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,553.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,156.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,685.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,065.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,983.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,189.92
|
| Rate for Payer: Cash Price |
$1,191.90
|
| Rate for Payer: Cigna Commercial |
$3,801.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,312.29
|
| Rate for Payer: Health EOS Commercial |
$3,677.41
|
| Rate for Payer: HFN Commercial |
$3,801.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,098.94
|
| Rate for Payer: Multiplan Commercial |
$3,305.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,479.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,024.64
|
| Rate for Payer: Quartz Commercial |
$2,685.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,479.15
|
| Rate for Payer: The Alliance Commercial |
$2,065.96
|
| Rate for Payer: WEA Trust Commercial |
$2,272.56
|
| Rate for Payer: WPS Commercial |
$3,060.40
|
|
|
CATHETER WORD BARTHOLIN GLAND 564000
|
Facility
|
OP
|
$443.00
|
|
| Hospital Charge Code |
2965793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$129.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.83
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.54
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$276.43
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$299.47
|
| Rate for Payer: Quartz Medicare Advantage |
$276.43
|
| Rate for Payer: The Alliance Commercial |
$230.36
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
CATHETER WORD BARTHOLIN GLAND 564000
|
Facility
|
IP
|
$443.00
|
|
| Hospital Charge Code |
2965793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$276.43
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
CATHETHER SOLENT OMNI #109681-001
|
Facility
|
IP
|
$11,716.00
|
|
| Hospital Charge Code |
2973882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,970.47 |
| Max. Negotiated Rate |
$11,209.87 |
| Rate for Payer: Aetna Commercial |
$10,966.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,478.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,457.86
|
| Rate for Payer: Cash Price |
$3,514.80
|
| Rate for Payer: Cigna Commercial |
$11,209.87
|
| Rate for Payer: Health EOS Commercial |
$10,844.33
|
| Rate for Payer: HFN Commercial |
$11,209.87
|
| Rate for Payer: Multiplan Commercial |
$9,747.71
|
| Rate for Payer: Preferred Network Access Commercial |
$11,209.87
|
| Rate for Payer: Quartz Beloit One Network |
$5,970.47
|
| Rate for Payer: Quartz Commercial |
$7,310.78
|
| Rate for Payer: WEA Trust Commercial |
$6,701.55
|
| Rate for Payer: WPS Commercial |
$9,024.83
|
|
|
CATHETHER SOLENT OMNI #109681-001
|
Facility
|
OP
|
$11,716.00
|
|
| Hospital Charge Code |
2973882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,411.70 |
| Max. Negotiated Rate |
$11,209.87 |
| Rate for Payer: Aetna Commercial |
$10,966.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,478.79
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,920.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,092.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,848.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,457.86
|
| Rate for Payer: Cash Price |
$3,514.80
|
| Rate for Payer: Cigna Commercial |
$11,209.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,818.71
|
| Rate for Payer: Health EOS Commercial |
$10,844.33
|
| Rate for Payer: HFN Commercial |
$11,209.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,138.48
|
| Rate for Payer: Multiplan Commercial |
$9,747.71
|
| Rate for Payer: NAPHCARE Commercial |
$7,310.78
|
| Rate for Payer: Preferred Network Access Commercial |
$11,209.87
|
| Rate for Payer: Quartz Beloit One Network |
$5,970.47
|
| Rate for Payer: Quartz Commercial |
$7,920.02
|
| Rate for Payer: Quartz Medicare Advantage |
$7,310.78
|
| Rate for Payer: The Alliance Commercial |
$6,092.32
|
| Rate for Payer: WEA Trust Commercial |
$6,701.55
|
| Rate for Payer: WPS Commercial |
$9,024.83
|
|
|
CATH FEMORAL ARTERY SAC-00820-PBX
|
Facility
|
IP
|
$448.00
|
|
| Hospital Charge Code |
5641661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$419.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.94
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$428.65
|
| Rate for Payer: Health EOS Commercial |
$414.67
|
| Rate for Payer: HFN Commercial |
$428.65
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: Preferred Network Access Commercial |
$428.65
|
| Rate for Payer: Quartz Beloit One Network |
$228.30
|
| Rate for Payer: Quartz Commercial |
$279.55
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
|
CATH FEMORAL ARTERY SAC-00820-PBX
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
5641661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$419.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Aetna Managed Medicare |
$130.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.94
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$428.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.74
|
| Rate for Payer: Health EOS Commercial |
$414.67
|
| Rate for Payer: HFN Commercial |
$428.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.44
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: NAPHCARE Commercial |
$279.55
|
| Rate for Payer: Preferred Network Access Commercial |
$428.65
|
| Rate for Payer: Quartz Beloit One Network |
$228.30
|
| Rate for Payer: Quartz Commercial |
$302.85
|
| Rate for Payer: Quartz Medicare Advantage |
$279.55
|
| Rate for Payer: The Alliance Commercial |
$232.96
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
|
Cathflow 1 mg Charge
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
2958917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$388.82 |
| Max. Negotiated Rate |
$730.04 |
| Rate for Payer: Aetna Commercial |
$714.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.57
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$730.04
|
| Rate for Payer: Health EOS Commercial |
$706.23
|
| Rate for Payer: HFN Commercial |
$730.04
|
| Rate for Payer: Multiplan Commercial |
$634.82
|
| Rate for Payer: Preferred Network Access Commercial |
$730.04
|
| Rate for Payer: Quartz Beloit One Network |
$388.82
|
| Rate for Payer: Quartz Commercial |
$476.11
|
| Rate for Payer: WEA Trust Commercial |
$436.44
|
| Rate for Payer: WPS Commercial |
$587.74
|
|
|
Cathflow 1 mg Charge
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
2958917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.37 |
| Max. Negotiated Rate |
$753.84 |
| Rate for Payer: Aetna Commercial |
$753.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.43
|
| Rate for Payer: Aetna Managed Medicare |
$102.53
|
| Rate for Payer: Anthem Medicare Advantage |
$102.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$753.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.37
|
| Rate for Payer: Health EOS Commercial |
$722.10
|
| Rate for Payer: HFN Commercial |
$753.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.53
|
| Rate for Payer: Multiplan Commercial |
$634.82
|
| Rate for Payer: NAPHCARE Commercial |
$153.80
|
| Rate for Payer: Preferred Network Access Commercial |
$753.84
|
| Rate for Payer: Quartz Beloit One Network |
$349.15
|
| Rate for Payer: Quartz Commercial |
$452.31
|
| Rate for Payer: Quartz Medicare Advantage |
$102.53
|
| Rate for Payer: The Alliance Commercial |
$281.97
|
| Rate for Payer: United Healthcare Medicaid |
$97.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.53
|
| Rate for Payer: WEA Trust Commercial |
$436.44
|
| Rate for Payer: WPS Commercial |
$230.94
|
|
|
Cathflow 1 mg Charge
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
2958917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$730.04 |
| Rate for Payer: Aetna Commercial |
$714.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.43
|
| Rate for Payer: Aetna Managed Medicare |
$102.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$515.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.89
|
| Rate for Payer: Anthem Medicare Advantage |
$102.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cigna Commercial |
$730.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$102.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$102.53
|
| Rate for Payer: Health EOS Commercial |
$706.23
|
| Rate for Payer: HFN Commercial |
$730.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$381.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$102.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$102.53
|
| Rate for Payer: Multiplan Commercial |
$634.82
|
| Rate for Payer: NAPHCARE Commercial |
$153.80
|
| Rate for Payer: Preferred Network Access Commercial |
$730.04
|
| Rate for Payer: Quartz Beloit One Network |
$388.82
|
| Rate for Payer: Quartz Commercial |
$515.79
|
| Rate for Payer: Quartz Medicare Advantage |
$102.53
|
| Rate for Payer: The Alliance Commercial |
$410.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.53
|
| Rate for Payer: WEA Trust Commercial |
$436.44
|
| Rate for Payer: Wellcare Medicare |
$102.53
|
| Rate for Payer: WPS Commercial |
$230.94
|
|
|
CATH.FOGARTY IRRIG.10 FR***DISC** DEDE 4/21
|
Facility
|
OP
|
$526.00
|
|
| Hospital Charge Code |
2963452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.17 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$153.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.13
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$328.22
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$355.58
|
| Rate for Payer: Quartz Medicare Advantage |
$328.22
|
| Rate for Payer: The Alliance Commercial |
$273.52
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
CATH.FOGARTY IRRIG.10 FR***DISC** DEDE 4/21
|
Facility
|
IP
|
$526.00
|
|
| Hospital Charge Code |
2963452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$328.22
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
CATH GARD SHIELD 7 & 7.5 FR
|
Facility
|
OP
|
$274.00
|
|
| Hospital Charge Code |
2962976
|
|
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 7 & 7.5 FR
|
Facility
|
IP
|
$274.00
|
|
| Hospital Charge Code |
2962976
|
|
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 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
|
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 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 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
|
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 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 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
|
|
