|
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
|
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-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 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 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 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
|
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 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 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
|
|
|
CATH THORACIC 8FR 8008
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
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 THROMBECTOMY SYNTEL FOGARTY 4F X 50CM A4545
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
6207018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.39 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,191.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$880.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$916.76
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
CATH THROMBECTOMY SYNTEL FOGARTY 4F X 50CM A4545
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
6207018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
|
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.27 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,382.78
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
|
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.30 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Aetna Managed Medicare |
$645.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.71
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,728.48
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,498.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,382.78
|
| Rate for Payer: The Alliance Commercial |
$1,152.32
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
|
IP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.80 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,319.76
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
|
OP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.89 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Aetna Managed Medicare |
$615.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,429.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.93
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,649.70
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,319.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,429.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,319.76
|
| Rate for Payer: The Alliance Commercial |
$1,099.80
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
CATH TRAY MAHURKAR STR 12FR X 13.0 8888221313
|
Facility
|
OP
|
$2,198.00
|
|
| Hospital Charge Code |
2963063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$2,103.05 |
| Rate for Payer: Aetna Commercial |
$2,057.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| Rate for Payer: Aetna Managed Medicare |
$640.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,485.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,142.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.54
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,103.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$2,034.47
|
| Rate for Payer: HFN Commercial |
$2,103.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,714.44
|
| Rate for Payer: Multiplan Commercial |
$1,828.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,371.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.10
|
| Rate for Payer: Quartz Commercial |
$1,485.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,371.55
|
| Rate for Payer: The Alliance Commercial |
$1,142.96
|
| Rate for Payer: WEA Trust Commercial |
$1,257.26
|
| Rate for Payer: WPS Commercial |
$1,693.12
|
|
|
CATH TRAY MAHURKAR STR 12FR X 13.0 8888221313
|
Facility
|
IP
|
$2,198.00
|
|
| Hospital Charge Code |
2963063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.10 |
| Max. Negotiated Rate |
$2,103.05 |
| Rate for Payer: Aetna Commercial |
$2,057.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.54
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,103.05
|
| Rate for Payer: Health EOS Commercial |
$2,034.47
|
| Rate for Payer: HFN Commercial |
$2,103.05
|
| Rate for Payer: Multiplan Commercial |
$1,828.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.10
|
| Rate for Payer: Quartz Commercial |
$1,371.55
|
| Rate for Payer: WEA Trust Commercial |
$1,257.26
|
| Rate for Payer: WPS Commercial |
$1,693.12
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
|
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.30 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Aetna Managed Medicare |
$645.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.71
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,728.48
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,498.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,382.78
|
| Rate for Payer: The Alliance Commercial |
$1,152.32
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
|
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.27 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,382.78
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
