|
Intro Cath Venous
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
4378728
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$202.44 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$650.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.78
|
| Rate for Payer: Aetna Managed Medicare |
$202.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$469.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$361.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.19
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$665.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$643.47
|
| Rate for Payer: HFN Commercial |
$665.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.25
|
| Rate for Payer: Multiplan Commercial |
$578.40
|
| Rate for Payer: NAPHCARE Commercial |
$433.80
|
| Rate for Payer: Preferred Network Access Commercial |
$665.16
|
| Rate for Payer: Quartz Beloit One Network |
$354.27
|
| Rate for Payer: Quartz Commercial |
$469.95
|
| Rate for Payer: Quartz Medicare Advantage |
$433.80
|
| Rate for Payer: The Alliance Commercial |
$2,892.00
|
| Rate for Payer: WEA Trust Commercial |
$397.65
|
| Rate for Payer: WPS Commercial |
$535.53
|
|
|
Intro Cath Venous
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
4378728
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.27 |
| Max. Negotiated Rate |
$665.16 |
| Rate for Payer: Aetna Commercial |
$650.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.19
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$665.16
|
| Rate for Payer: Health EOS Commercial |
$643.47
|
| Rate for Payer: HFN Commercial |
$665.16
|
| Rate for Payer: Multiplan Commercial |
$578.40
|
| Rate for Payer: NAPHCARE Commercial |
$433.80
|
| Rate for Payer: Preferred Network Access Commercial |
$665.16
|
| Rate for Payer: Quartz Beloit One Network |
$354.27
|
| Rate for Payer: Quartz Commercial |
$433.80
|
| Rate for Payer: WEA Trust Commercial |
$397.65
|
| Rate for Payer: WPS Commercial |
$535.53
|
|
|
INTRODUCER 7FR
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.76 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Aetna Managed Medicare |
$312.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$558.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.07
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$837.75
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$726.05
|
| Rate for Payer: Quartz Medicare Advantage |
$670.20
|
| Rate for Payer: The Alliance Commercial |
$4,468.00
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
INTRODUCER 7FR
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.33 |
| Max. Negotiated Rate |
$1,027.64 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$670.20
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
INTRODUCER 7FR. RDC GUIDING 4037553A
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
2972130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.74 |
| Max. Negotiated Rate |
$1,127.92 |
| Rate for Payer: Aetna Commercial |
$1,103.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.78
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,127.92
|
| Rate for Payer: Health EOS Commercial |
$1,091.14
|
| Rate for Payer: HFN Commercial |
$1,127.92
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: NAPHCARE Commercial |
$735.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.92
|
| Rate for Payer: Quartz Beloit One Network |
$600.74
|
| Rate for Payer: Quartz Commercial |
$735.60
|
| Rate for Payer: WEA Trust Commercial |
$674.30
|
| Rate for Payer: WPS Commercial |
$908.10
|
|
|
INTRODUCER 7FR. RDC GUIDING 4037553A
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
2972130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.28 |
| Max. Negotiated Rate |
$4,904.00 |
| Rate for Payer: Aetna Commercial |
$1,103.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.36
|
| Rate for Payer: Aetna Managed Medicare |
$343.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$796.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.78
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,127.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.07
|
| Rate for Payer: Health EOS Commercial |
$1,091.14
|
| Rate for Payer: HFN Commercial |
$1,127.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$919.50
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: NAPHCARE Commercial |
$735.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.92
|
| Rate for Payer: Quartz Beloit One Network |
$600.74
|
| Rate for Payer: Quartz Commercial |
$796.90
|
| Rate for Payer: Quartz Medicare Advantage |
$735.60
|
| Rate for Payer: The Alliance Commercial |
$4,904.00
|
| Rate for Payer: WEA Trust Commercial |
$674.30
|
| Rate for Payer: WPS Commercial |
$908.10
|
|
|
INTRODUCER 8fr. HS 403-8553H
|
Facility
|
IP
|
$1,188.00
|
|
| Hospital Charge Code |
2972095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
INTRODUCER 8fr. HS 403-8553H
|
Facility
|
OP
|
$1,188.00
|
|
| Hospital Charge Code |
2972095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$4,752.00 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$772.20
|
| Rate for Payer: Quartz Medicare Advantage |
$712.80
|
| Rate for Payer: The Alliance Commercial |
$4,752.00
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
INTRODUCER BOUGIE ADULT 9-0212-70
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
2963462
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
|
|
INTRODUCER BOUGIE ADULT 9-0212-70
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
2963462
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
INTRODUCER FLOW GARD 9FR LEAD
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.76 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Aetna Managed Medicare |
$312.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$558.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.07
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$837.75
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$726.05
|
| Rate for Payer: Quartz Medicare Advantage |
$670.20
|
| Rate for Payer: The Alliance Commercial |
$4,468.00
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
INTRODUCER FLOW GARD 9FR LEAD
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.33 |
| Max. Negotiated Rate |
$1,027.64 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$670.20
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
INTRODUCER FLOW GUARD 7fr
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.33 |
| Max. Negotiated Rate |
$1,027.64 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$670.20
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
INTRODUCER FLOW GUARD 7fr
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.76 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Aetna Managed Medicare |
$312.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$558.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.07
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$837.75
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$726.05
|
| Rate for Payer: Quartz Medicare Advantage |
$670.20
|
| Rate for Payer: The Alliance Commercial |
$4,468.00
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
INTRODUCER GROSHONG 15 GA SPLT 4035403
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
2963838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.32 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna Commercial |
$332.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Aetna Managed Medicare |
$103.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.57
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$339.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.49
|
| Rate for Payer: Health EOS Commercial |
$328.41
|
| Rate for Payer: HFN Commercial |
$339.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.75
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: NAPHCARE Commercial |
$221.40
|
| Rate for Payer: Preferred Network Access Commercial |
$339.48
|
| Rate for Payer: Quartz Beloit One Network |
$180.81
|
| Rate for Payer: Quartz Commercial |
$239.85
|
| Rate for Payer: Quartz Medicare Advantage |
$221.40
|
| Rate for Payer: The Alliance Commercial |
$1,476.00
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
INTRODUCER GROSHONG 15 GA SPLT 4035403
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
2963838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$339.48 |
| Rate for Payer: Aetna Commercial |
$332.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.57
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$339.48
|
| Rate for Payer: Health EOS Commercial |
$328.41
|
| Rate for Payer: HFN Commercial |
$339.48
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: NAPHCARE Commercial |
$221.40
|
| Rate for Payer: Preferred Network Access Commercial |
$339.48
|
| Rate for Payer: Quartz Beloit One Network |
$180.81
|
| Rate for Payer: Quartz Commercial |
$221.40
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
INTRODUCER KIT LAPAROSCOPIC 12FR J-TUBE/G-TUBE 10250
|
Facility
|
IP
|
$2,849.00
|
|
| Hospital Charge Code |
5286771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,396.01 |
| Max. Negotiated Rate |
$2,621.08 |
| Rate for Payer: Aetna Commercial |
$2,564.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,450.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.97
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,621.08
|
| Rate for Payer: Health EOS Commercial |
$2,535.61
|
| Rate for Payer: HFN Commercial |
$2,621.08
|
| Rate for Payer: Multiplan Commercial |
$2,279.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,709.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,621.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.01
|
| Rate for Payer: Quartz Commercial |
$1,709.40
|
| Rate for Payer: WEA Trust Commercial |
$1,566.95
|
| Rate for Payer: WPS Commercial |
$2,110.25
|
|
|
INTRODUCER KIT LAPAROSCOPIC 12FR J-TUBE/G-TUBE 10250
|
Facility
|
OP
|
$2,849.00
|
|
| Hospital Charge Code |
5286771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$797.72 |
| Max. Negotiated Rate |
$11,396.00 |
| Rate for Payer: Aetna Commercial |
$2,564.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,450.14
|
| Rate for Payer: Aetna Managed Medicare |
$797.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,851.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,424.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,367.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.97
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,621.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,594.30
|
| Rate for Payer: Health EOS Commercial |
$2,535.61
|
| Rate for Payer: HFN Commercial |
$2,621.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,136.75
|
| Rate for Payer: Multiplan Commercial |
$2,279.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,709.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,621.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.01
|
| Rate for Payer: Quartz Commercial |
$1,851.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,709.40
|
| Rate for Payer: The Alliance Commercial |
$11,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,566.95
|
| Rate for Payer: WPS Commercial |
$2,110.25
|
|
|
INTRODUCER KIT LAPAROSCOPIC 18FR G-TUBE 10237
|
Facility
|
OP
|
$2,849.00
|
|
| Hospital Charge Code |
5286772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$797.72 |
| Max. Negotiated Rate |
$11,396.00 |
| Rate for Payer: Aetna Commercial |
$2,564.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,450.14
|
| Rate for Payer: Aetna Managed Medicare |
$797.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,851.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,424.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,367.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.97
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,621.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,594.30
|
| Rate for Payer: Health EOS Commercial |
$2,535.61
|
| Rate for Payer: HFN Commercial |
$2,621.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,136.75
|
| Rate for Payer: Multiplan Commercial |
$2,279.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,709.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,621.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.01
|
| Rate for Payer: Quartz Commercial |
$1,851.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,709.40
|
| Rate for Payer: The Alliance Commercial |
$11,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,566.95
|
| Rate for Payer: WPS Commercial |
$2,110.25
|
|
|
INTRODUCER KIT LAPAROSCOPIC 18FR G-TUBE 10237
|
Facility
|
IP
|
$2,849.00
|
|
| Hospital Charge Code |
5286772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,396.01 |
| Max. Negotiated Rate |
$2,621.08 |
| Rate for Payer: Aetna Commercial |
$2,564.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,450.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.97
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,621.08
|
| Rate for Payer: Health EOS Commercial |
$2,535.61
|
| Rate for Payer: HFN Commercial |
$2,621.08
|
| Rate for Payer: Multiplan Commercial |
$2,279.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,709.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,621.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.01
|
| Rate for Payer: Quartz Commercial |
$1,709.40
|
| Rate for Payer: WEA Trust Commercial |
$1,566.95
|
| Rate for Payer: WPS Commercial |
$2,110.25
|
|
|
INTRODUCER KIT LAPAROSCOPIC 20FR G-TUBE 10226
|
Facility
|
IP
|
$2,849.00
|
|
| Hospital Charge Code |
5286773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,396.01 |
| Max. Negotiated Rate |
$2,621.08 |
| Rate for Payer: Aetna Commercial |
$2,564.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,450.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.97
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,621.08
|
| Rate for Payer: Health EOS Commercial |
$2,535.61
|
| Rate for Payer: HFN Commercial |
$2,621.08
|
| Rate for Payer: Multiplan Commercial |
$2,279.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,709.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,621.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.01
|
| Rate for Payer: Quartz Commercial |
$1,709.40
|
| Rate for Payer: WEA Trust Commercial |
$1,566.95
|
| Rate for Payer: WPS Commercial |
$2,110.25
|
|
|
INTRODUCER KIT LAPAROSCOPIC 20FR G-TUBE 10226
|
Facility
|
OP
|
$2,849.00
|
|
| Hospital Charge Code |
5286773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$797.72 |
| Max. Negotiated Rate |
$11,396.00 |
| Rate for Payer: Aetna Commercial |
$2,564.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,450.14
|
| Rate for Payer: Aetna Managed Medicare |
$797.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,851.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,424.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,367.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.97
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,621.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,594.30
|
| Rate for Payer: Health EOS Commercial |
$2,535.61
|
| Rate for Payer: HFN Commercial |
$2,621.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,136.75
|
| Rate for Payer: Multiplan Commercial |
$2,279.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,709.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,621.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.01
|
| Rate for Payer: Quartz Commercial |
$1,851.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,709.40
|
| Rate for Payer: The Alliance Commercial |
$11,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,566.95
|
| Rate for Payer: WPS Commercial |
$2,110.25
|
|
|
INTRODUCER RFA FDI-17-100-4
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
5415149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.41 |
| Max. Negotiated Rate |
$1,204.28 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$785.40
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
INTRODUCER RFA FDI-17-100-4
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
5415149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$5,236.00 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Aetna Managed Medicare |
$366.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.52
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.75
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$850.85
|
| Rate for Payer: Quartz Medicare Advantage |
$785.40
|
| Rate for Payer: The Alliance Commercial |
$5,236.00
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
INTRODUCER SAFESHEATH
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
2972101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Aetna Managed Medicare |
$333.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.92
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.50
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$773.50
|
| Rate for Payer: Quartz Medicare Advantage |
$714.00
|
| Rate for Payer: The Alliance Commercial |
$4,760.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
