|
INSERTER TIGHTROPE BUTTON AR-2262
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
INSERTER TIGHTROPE BUTTON AR-2262
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 61MM EVERGRIP61
|
Facility
|
OP
|
$666.00
|
|
| Hospital Charge Code |
5496808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.94 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Aetna Managed Medicare |
$193.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.61
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: NAPHCARE Commercial |
$415.58
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$450.22
|
| Rate for Payer: Quartz Medicare Advantage |
$415.58
|
| Rate for Payer: The Alliance Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 61MM EVERGRIP61
|
Facility
|
IP
|
$666.00
|
|
| Hospital Charge Code |
5496808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.39 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$415.58
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 86MM EVERGRIP86
|
Facility
|
IP
|
$666.00
|
|
| Hospital Charge Code |
5520745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.39 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$415.58
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 86MM EVERGRIP86
|
Facility
|
OP
|
$666.00
|
|
| Hospital Charge Code |
5520745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.94 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Aetna Managed Medicare |
$193.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.61
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: NAPHCARE Commercial |
$415.58
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$450.22
|
| Rate for Payer: Quartz Medicare Advantage |
$415.58
|
| Rate for Payer: The Alliance Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
Insertion Femoral Artery
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3101787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Aetna Managed Medicare |
$381.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.84
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.02
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: NAPHCARE Commercial |
$816.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$884.88
|
| Rate for Payer: Quartz Medicare Advantage |
$816.82
|
| Rate for Payer: The Alliance Commercial |
$680.68
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
Insertion Femoral Artery
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3101787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.07 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$816.82
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
Insertion Femor Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.58 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Aetna Managed Medicare |
$394.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.61
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.90
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: NAPHCARE Commercial |
$845.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$915.98
|
| Rate for Payer: Quartz Medicare Advantage |
$845.52
|
| Rate for Payer: The Alliance Commercial |
$704.60
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
Insertion Femor Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$690.51 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$845.52
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
INSERTION GUIDE SYNTH 323.050
|
Facility
|
IP
|
$7,633.00
|
|
| Hospital Charge Code |
2966609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,889.78 |
| Max. Negotiated Rate |
$7,303.25 |
| Rate for Payer: Aetna Commercial |
$7,144.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,207.31
|
| Rate for Payer: Cash Price |
$2,289.90
|
| Rate for Payer: Cigna Commercial |
$7,303.25
|
| Rate for Payer: Health EOS Commercial |
$7,065.10
|
| Rate for Payer: HFN Commercial |
$7,303.25
|
| Rate for Payer: Multiplan Commercial |
$6,350.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,303.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.78
|
| Rate for Payer: Quartz Commercial |
$4,762.99
|
| Rate for Payer: WEA Trust Commercial |
$4,366.08
|
| Rate for Payer: WPS Commercial |
$5,879.70
|
|
|
INSERTION GUIDE SYNTH 323.050
|
Facility
|
OP
|
$7,633.00
|
|
| Hospital Charge Code |
2966609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,222.73 |
| Max. Negotiated Rate |
$7,303.25 |
| Rate for Payer: Aetna Commercial |
$7,144.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,222.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,159.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,969.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,810.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,207.31
|
| Rate for Payer: Cash Price |
$2,289.90
|
| Rate for Payer: Cigna Commercial |
$7,303.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,442.41
|
| Rate for Payer: Health EOS Commercial |
$7,065.10
|
| Rate for Payer: HFN Commercial |
$7,303.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,953.74
|
| Rate for Payer: Multiplan Commercial |
$6,350.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,303.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.78
|
| Rate for Payer: Quartz Commercial |
$5,159.91
|
| Rate for Payer: Quartz Medicare Advantage |
$4,762.99
|
| Rate for Payer: The Alliance Commercial |
$3,969.16
|
| Rate for Payer: WEA Trust Commercial |
$4,366.08
|
| Rate for Payer: WPS Commercial |
$5,879.70
|
|
|
Insertion Jugular Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.58 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Aetna Managed Medicare |
$394.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.61
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.90
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: NAPHCARE Commercial |
$845.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$915.98
|
| Rate for Payer: Quartz Medicare Advantage |
$845.52
|
| Rate for Payer: The Alliance Commercial |
$704.60
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
Insertion Jugular Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$690.51 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$845.52
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
INSERTION KIT FIBERTAK 1.8MM PERCUTANEOUS AR-3610PK-3
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5804229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.34 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Aetna Managed Medicare |
$670.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.76
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.56
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,556.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.45
|
| Rate for Payer: The Alliance Commercial |
$1,197.04
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
INSERTION KIT FIBERTAK 1.8MM PERCUTANEOUS AR-3610PK-3
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5804229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.10 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,436.45
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
Insertion LVAD-IMPELLA
|
Facility
|
IP
|
$164,248.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
5128679
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$83,700.78 |
| Max. Negotiated Rate |
$157,152.49 |
| Rate for Payer: Aetna Commercial |
$153,736.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146,903.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90,533.50
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cigna Commercial |
$157,152.49
|
| Rate for Payer: Health EOS Commercial |
$152,027.95
|
| Rate for Payer: HFN Commercial |
$157,152.49
|
| Rate for Payer: Multiplan Commercial |
$136,654.34
|
| Rate for Payer: Preferred Network Access Commercial |
$157,152.49
|
| Rate for Payer: Quartz Beloit One Network |
$83,700.78
|
| Rate for Payer: Quartz Commercial |
$102,490.75
|
| Rate for Payer: WEA Trust Commercial |
$93,949.86
|
| Rate for Payer: WPS Commercial |
$126,520.23
|
|
|
Insertion LVAD-IMPELLA
|
Facility
|
OP
|
$164,248.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
5128679
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,147.49 |
| Max. Negotiated Rate |
$157,152.49 |
| Rate for Payer: Aetna Commercial |
$153,736.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146,903.41
|
| Rate for Payer: Aetna Managed Medicare |
$47,829.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111,031.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85,408.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81,992.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90,533.50
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cigna Commercial |
$157,152.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$152,027.95
|
| Rate for Payer: HFN Commercial |
$157,152.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128,113.44
|
| Rate for Payer: Multiplan Commercial |
$136,654.34
|
| Rate for Payer: NAPHCARE Commercial |
$102,490.75
|
| Rate for Payer: Preferred Network Access Commercial |
$157,152.49
|
| Rate for Payer: Quartz Beloit One Network |
$83,700.78
|
| Rate for Payer: Quartz Commercial |
$111,031.65
|
| Rate for Payer: Quartz Medicare Advantage |
$102,490.75
|
| Rate for Payer: The Alliance Commercial |
$1,147.49
|
| Rate for Payer: WEA Trust Commercial |
$93,949.86
|
| Rate for Payer: WPS Commercial |
$126,520.23
|
|
|
INSERTION OF CATHETER, VEIN 36510
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
3014529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna Commercial |
$666.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$44.89
|
| Rate for Payer: Anthem Medicare Advantage |
$44.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.89
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$666.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.89
|
| Rate for Payer: Health EOS Commercial |
$638.82
|
| Rate for Payer: HFN Commercial |
$666.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.89
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.33
|
| Rate for Payer: Preferred Network Access Commercial |
$666.90
|
| Rate for Payer: Quartz Beloit One Network |
$308.88
|
| Rate for Payer: Quartz Commercial |
$400.14
|
| Rate for Payer: Quartz Medicare Advantage |
$44.89
|
| Rate for Payer: The Alliance Commercial |
$190.77
|
| Rate for Payer: United Healthcare Medicaid |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.89
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$201.99
|
|
|
Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
3023773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$588.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.58
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.00
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$601.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$582.20
|
| Rate for Payer: HFN Commercial |
$601.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$523.33
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$601.83
|
| Rate for Payer: Quartz Beloit One Network |
$320.54
|
| Rate for Payer: Quartz Commercial |
$425.20
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$359.79
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$484.52
|
|
|
Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
3023773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$621.45 |
| Rate for Payer: Aetna Commercial |
$621.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.58
|
| Rate for Payer: Aetna Managed Medicare |
$51.45
|
| Rate for Payer: Anthem Medicare Advantage |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.45
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$621.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.45
|
| Rate for Payer: Health EOS Commercial |
$595.29
|
| Rate for Payer: HFN Commercial |
$621.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$216.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$523.33
|
| Rate for Payer: NAPHCARE Commercial |
$77.17
|
| Rate for Payer: Preferred Network Access Commercial |
$621.45
|
| Rate for Payer: Quartz Beloit One Network |
$287.83
|
| Rate for Payer: Quartz Commercial |
$372.87
|
| Rate for Payer: Quartz Medicare Advantage |
$51.45
|
| Rate for Payer: The Alliance Commercial |
$218.66
|
| Rate for Payer: United Healthcare Medicaid |
$372.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: WEA Trust Commercial |
$359.79
|
| Rate for Payer: WPS Commercial |
$231.52
|
|
|
Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
3023773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.54 |
| Max. Negotiated Rate |
$601.83 |
| Rate for Payer: Aetna Commercial |
$588.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$601.83
|
| Rate for Payer: Health EOS Commercial |
$582.20
|
| Rate for Payer: HFN Commercial |
$601.83
|
| Rate for Payer: Multiplan Commercial |
$523.33
|
| Rate for Payer: Preferred Network Access Commercial |
$601.83
|
| Rate for Payer: Quartz Beloit One Network |
$320.54
|
| Rate for Payer: Quartz Commercial |
$392.50
|
| Rate for Payer: WEA Trust Commercial |
$359.79
|
| Rate for Payer: WPS Commercial |
$484.52
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$1,056.17 |
| Rate for Payer: Aetna Commercial |
$1,056.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$96.99
|
| Rate for Payer: Anthem Medicare Advantage |
$96.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.99
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,056.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.99
|
| Rate for Payer: Health EOS Commercial |
$1,011.70
|
| Rate for Payer: HFN Commercial |
$1,056.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$387.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.99
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$145.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.17
|
| Rate for Payer: Quartz Beloit One Network |
$489.17
|
| Rate for Payer: Quartz Commercial |
$633.70
|
| Rate for Payer: Quartz Medicare Advantage |
$96.99
|
| Rate for Payer: The Alliance Commercial |
$412.21
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.99
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$436.46
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$533.64 |
| Max. Negotiated Rate |
$9,714.93 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$722.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$555.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$533.64
|
| Rate for Payer: Anthem Medicare Advantage |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$722.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$544.76 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$667.06
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
