|
INTRODUCER FLOW GARD 9FR LEAD
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.27 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Aetna Managed Medicare |
$325.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.09
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.26
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: NAPHCARE Commercial |
$697.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$755.09
|
| Rate for Payer: Quartz Medicare Advantage |
$697.01
|
| Rate for Payer: The Alliance Commercial |
$580.84
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
INTRODUCER FLOW GARD 9FR LEAD
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.22 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$697.01
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
INTRODUCER FLOW GUARD 7fr
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.27 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Aetna Managed Medicare |
$325.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.09
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.26
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: NAPHCARE Commercial |
$697.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$755.09
|
| Rate for Payer: Quartz Medicare Advantage |
$697.01
|
| Rate for Payer: The Alliance Commercial |
$580.84
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
INTRODUCER FLOW GUARD 7fr
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.22 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$697.01
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
INTRODUCER GROSHONG 15 GA SPLT 4035403
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
2963838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
INTRODUCER GROSHONG 15 GA SPLT 4035403
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
2963838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
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 |
$1,451.85 |
| Max. Negotiated Rate |
$2,725.92 |
| Rate for Payer: Aetna Commercial |
$2,666.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,548.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,570.37
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,725.92
|
| Rate for Payer: Health EOS Commercial |
$2,637.03
|
| Rate for Payer: HFN Commercial |
$2,725.92
|
| Rate for Payer: Multiplan Commercial |
$2,370.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.85
|
| Rate for Payer: Quartz Commercial |
$1,777.78
|
| Rate for Payer: WEA Trust Commercial |
$1,629.63
|
| Rate for Payer: WPS Commercial |
$2,194.58
|
|
|
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 |
$829.63 |
| Max. Negotiated Rate |
$2,725.92 |
| Rate for Payer: Aetna Commercial |
$2,666.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,548.15
|
| Rate for Payer: Aetna Managed Medicare |
$829.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,925.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,481.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,422.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,570.37
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,725.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,658.12
|
| Rate for Payer: Health EOS Commercial |
$2,637.03
|
| Rate for Payer: HFN Commercial |
$2,725.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,222.22
|
| Rate for Payer: Multiplan Commercial |
$2,370.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,777.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.85
|
| Rate for Payer: Quartz Commercial |
$1,925.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,777.78
|
| Rate for Payer: The Alliance Commercial |
$1,481.48
|
| Rate for Payer: WEA Trust Commercial |
$1,629.63
|
| Rate for Payer: WPS Commercial |
$2,194.58
|
|
|
INTRODUCER KIT LAPAROSCOPIC 18FR G-TUBE 10237
|
Facility
|
IP
|
$2,849.00
|
|
| Hospital Charge Code |
5286772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,451.85 |
| Max. Negotiated Rate |
$2,725.92 |
| Rate for Payer: Aetna Commercial |
$2,666.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,548.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,570.37
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,725.92
|
| Rate for Payer: Health EOS Commercial |
$2,637.03
|
| Rate for Payer: HFN Commercial |
$2,725.92
|
| Rate for Payer: Multiplan Commercial |
$2,370.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.85
|
| Rate for Payer: Quartz Commercial |
$1,777.78
|
| Rate for Payer: WEA Trust Commercial |
$1,629.63
|
| Rate for Payer: WPS Commercial |
$2,194.58
|
|
|
INTRODUCER KIT LAPAROSCOPIC 18FR G-TUBE 10237
|
Facility
|
OP
|
$2,849.00
|
|
| Hospital Charge Code |
5286772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$829.63 |
| Max. Negotiated Rate |
$2,725.92 |
| Rate for Payer: Aetna Commercial |
$2,666.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,548.15
|
| Rate for Payer: Aetna Managed Medicare |
$829.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,925.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,481.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,422.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,570.37
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,725.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,658.12
|
| Rate for Payer: Health EOS Commercial |
$2,637.03
|
| Rate for Payer: HFN Commercial |
$2,725.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,222.22
|
| Rate for Payer: Multiplan Commercial |
$2,370.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,777.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.85
|
| Rate for Payer: Quartz Commercial |
$1,925.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,777.78
|
| Rate for Payer: The Alliance Commercial |
$1,481.48
|
| Rate for Payer: WEA Trust Commercial |
$1,629.63
|
| Rate for Payer: WPS Commercial |
$2,194.58
|
|
|
INTRODUCER KIT LAPAROSCOPIC 20FR G-TUBE 10226
|
Facility
|
OP
|
$2,849.00
|
|
| Hospital Charge Code |
5286773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$829.63 |
| Max. Negotiated Rate |
$2,725.92 |
| Rate for Payer: Aetna Commercial |
$2,666.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,548.15
|
| Rate for Payer: Aetna Managed Medicare |
$829.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,925.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,481.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,422.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,570.37
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,725.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,658.12
|
| Rate for Payer: Health EOS Commercial |
$2,637.03
|
| Rate for Payer: HFN Commercial |
$2,725.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,222.22
|
| Rate for Payer: Multiplan Commercial |
$2,370.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,777.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.85
|
| Rate for Payer: Quartz Commercial |
$1,925.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,777.78
|
| Rate for Payer: The Alliance Commercial |
$1,481.48
|
| Rate for Payer: WEA Trust Commercial |
$1,629.63
|
| Rate for Payer: WPS Commercial |
$2,194.58
|
|
|
INTRODUCER KIT LAPAROSCOPIC 20FR G-TUBE 10226
|
Facility
|
IP
|
$2,849.00
|
|
| Hospital Charge Code |
5286773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,451.85 |
| Max. Negotiated Rate |
$2,725.92 |
| Rate for Payer: Aetna Commercial |
$2,666.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,548.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,570.37
|
| Rate for Payer: Cash Price |
$854.70
|
| Rate for Payer: Cigna Commercial |
$2,725.92
|
| Rate for Payer: Health EOS Commercial |
$2,637.03
|
| Rate for Payer: HFN Commercial |
$2,725.92
|
| Rate for Payer: Multiplan Commercial |
$2,370.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.85
|
| Rate for Payer: Quartz Commercial |
$1,777.78
|
| Rate for Payer: WEA Trust Commercial |
$1,629.63
|
| Rate for Payer: WPS Commercial |
$2,194.58
|
|
|
INTRODUCER RFA FDI-17-100-4
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
5415149
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
INTRODUCER RFA FDI-17-100-4
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
5415149
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
INTRODUCER SAFESHEATH
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
2972101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Aetna Managed Medicare |
$346.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.58
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.20
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: NAPHCARE Commercial |
$742.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$804.44
|
| Rate for Payer: Quartz Medicare Advantage |
$742.56
|
| Rate for Payer: The Alliance Commercial |
$618.80
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
INTRODUCER SAFESHEATH
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
2972101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$742.56
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
INTRODUCER SHEATH 12FR
|
Facility
|
IP
|
$3,049.00
|
|
| Hospital Charge Code |
2973307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,553.77 |
| Max. Negotiated Rate |
$2,917.28 |
| Rate for Payer: Aetna Commercial |
$2,853.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.61
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,917.28
|
| Rate for Payer: Health EOS Commercial |
$2,822.15
|
| Rate for Payer: HFN Commercial |
$2,917.28
|
| Rate for Payer: Multiplan Commercial |
$2,536.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.77
|
| Rate for Payer: Quartz Commercial |
$1,902.58
|
| Rate for Payer: WEA Trust Commercial |
$1,744.03
|
| Rate for Payer: WPS Commercial |
$2,348.64
|
|
|
INTRODUCER SHEATH 12FR
|
Facility
|
OP
|
$3,049.00
|
|
| Hospital Charge Code |
2973307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.87 |
| Max. Negotiated Rate |
$2,917.28 |
| Rate for Payer: Aetna Commercial |
$2,853.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.03
|
| Rate for Payer: Aetna Managed Medicare |
$887.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,585.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.61
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,917.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.52
|
| Rate for Payer: Health EOS Commercial |
$2,822.15
|
| Rate for Payer: HFN Commercial |
$2,917.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,378.22
|
| Rate for Payer: Multiplan Commercial |
$2,536.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,902.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.77
|
| Rate for Payer: Quartz Commercial |
$2,061.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,902.58
|
| Rate for Payer: The Alliance Commercial |
$1,585.48
|
| Rate for Payer: WEA Trust Commercial |
$1,744.03
|
| Rate for Payer: WPS Commercial |
$2,348.64
|
|
|
INTRODUCER SHEATH 18FR
|
Facility
|
IP
|
$3,599.00
|
|
| Hospital Charge Code |
2973409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,834.05 |
| Max. Negotiated Rate |
$3,443.52 |
| Rate for Payer: Aetna Commercial |
$3,368.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,983.77
|
| Rate for Payer: Cash Price |
$1,079.70
|
| Rate for Payer: Cigna Commercial |
$3,443.52
|
| Rate for Payer: Health EOS Commercial |
$3,331.23
|
| Rate for Payer: HFN Commercial |
$3,443.52
|
| Rate for Payer: Multiplan Commercial |
$2,994.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,443.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,834.05
|
| Rate for Payer: Quartz Commercial |
$2,245.78
|
| Rate for Payer: WEA Trust Commercial |
$2,058.63
|
| Rate for Payer: WPS Commercial |
$2,772.31
|
|
|
INTRODUCER SHEATH 18FR
|
Facility
|
OP
|
$3,599.00
|
|
| Hospital Charge Code |
2973409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,048.03 |
| Max. Negotiated Rate |
$3,443.52 |
| Rate for Payer: Aetna Commercial |
$3,368.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,048.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,432.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,871.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,796.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,983.77
|
| Rate for Payer: Cash Price |
$1,079.70
|
| Rate for Payer: Cigna Commercial |
$3,443.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,094.62
|
| Rate for Payer: Health EOS Commercial |
$3,331.23
|
| Rate for Payer: HFN Commercial |
$3,443.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,807.22
|
| Rate for Payer: Multiplan Commercial |
$2,994.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,245.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,443.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,834.05
|
| Rate for Payer: Quartz Commercial |
$2,432.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,245.78
|
| Rate for Payer: The Alliance Commercial |
$1,871.48
|
| Rate for Payer: WEA Trust Commercial |
$2,058.63
|
| Rate for Payer: WPS Commercial |
$2,772.31
|
|
|
INTRODUCER TRANSPAC 42582-05
|
Facility
|
IP
|
$1,228.00
|
|
| Hospital Charge Code |
5520934
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.79 |
| Max. Negotiated Rate |
$1,174.95 |
| Rate for Payer: Aetna Commercial |
$1,149.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,098.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.87
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$1,174.95
|
| Rate for Payer: Health EOS Commercial |
$1,136.64
|
| Rate for Payer: HFN Commercial |
$1,174.95
|
| Rate for Payer: Multiplan Commercial |
$1,021.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,174.95
|
| Rate for Payer: Quartz Beloit One Network |
$625.79
|
| Rate for Payer: Quartz Commercial |
$766.27
|
| Rate for Payer: WEA Trust Commercial |
$702.42
|
| Rate for Payer: WPS Commercial |
$945.93
|
|
|
INTRODUCER TRANSPAC 42582-05
|
Facility
|
OP
|
$1,228.00
|
|
| Hospital Charge Code |
5520934
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.59 |
| Max. Negotiated Rate |
$1,174.95 |
| Rate for Payer: Aetna Commercial |
$1,149.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,098.32
|
| Rate for Payer: Aetna Managed Medicare |
$357.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$830.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.87
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$1,174.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.70
|
| Rate for Payer: Health EOS Commercial |
$1,136.64
|
| Rate for Payer: HFN Commercial |
$1,174.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.84
|
| Rate for Payer: Multiplan Commercial |
$1,021.70
|
| Rate for Payer: NAPHCARE Commercial |
$766.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,174.95
|
| Rate for Payer: Quartz Beloit One Network |
$625.79
|
| Rate for Payer: Quartz Commercial |
$830.13
|
| Rate for Payer: Quartz Medicare Advantage |
$766.27
|
| Rate for Payer: The Alliance Commercial |
$638.56
|
| Rate for Payer: WEA Trust Commercial |
$702.42
|
| Rate for Payer: WPS Commercial |
$945.93
|
|
|
INTRODUCTER FLOW GARD 7FR LEAD
|
Facility
|
IP
|
$7,448.00
|
|
| Hospital Charge Code |
2973432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,795.50 |
| Max. Negotiated Rate |
$7,126.25 |
| Rate for Payer: Aetna Commercial |
$6,971.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,661.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,105.34
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cigna Commercial |
$7,126.25
|
| Rate for Payer: Health EOS Commercial |
$6,893.87
|
| Rate for Payer: HFN Commercial |
$7,126.25
|
| Rate for Payer: Multiplan Commercial |
$6,196.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,126.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,795.50
|
| Rate for Payer: Quartz Commercial |
$4,647.55
|
| Rate for Payer: WEA Trust Commercial |
$4,260.26
|
| Rate for Payer: WPS Commercial |
$5,737.19
|
|
|
INTRODUCTER FLOW GARD 7FR LEAD
|
Facility
|
OP
|
$7,448.00
|
|
| Hospital Charge Code |
2973432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,168.86 |
| Max. Negotiated Rate |
$7,126.25 |
| Rate for Payer: Aetna Commercial |
$6,971.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,661.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,034.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,872.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,718.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,105.34
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cigna Commercial |
$7,126.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,334.74
|
| Rate for Payer: Health EOS Commercial |
$6,893.87
|
| Rate for Payer: HFN Commercial |
$7,126.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,809.44
|
| Rate for Payer: Multiplan Commercial |
$6,196.74
|
| Rate for Payer: NAPHCARE Commercial |
$4,647.55
|
| Rate for Payer: Preferred Network Access Commercial |
$7,126.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,795.50
|
| Rate for Payer: Quartz Commercial |
$5,034.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,647.55
|
| Rate for Payer: The Alliance Commercial |
$3,872.96
|
| Rate for Payer: WEA Trust Commercial |
$4,260.26
|
| Rate for Payer: WPS Commercial |
$5,737.19
|
|
|
INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 36140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$290.78 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: The Alliance Commercial |
$290.78
|
|
