|
Intro Cath/Stent Renal Pelvis
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Commercial |
$4,717.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,507.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,407.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,620.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,515.97
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,778.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,822.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Health EOS Commercial |
$4,665.02
|
| Rate for Payer: HFN Commercial |
$4,822.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: Multiplan Commercial |
$4,193.28
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,822.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.38
|
| Rate for Payer: Quartz Commercial |
$3,407.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,882.88
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
| Rate for Payer: WPS Commercial |
$3,882.31
|
|
|
Intro Cath Venous
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
4378728
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$368.44 |
| Max. Negotiated Rate |
$691.77 |
| Rate for Payer: Aetna Commercial |
$676.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$691.77
|
| Rate for Payer: Health EOS Commercial |
$669.21
|
| Rate for Payer: HFN Commercial |
$691.77
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$691.77
|
| Rate for Payer: Quartz Beloit One Network |
$368.44
|
| Rate for Payer: Quartz Commercial |
$451.15
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: WPS Commercial |
$556.93
|
|
|
Intro Cath Venous
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
4378728
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$210.54 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$676.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Aetna Managed Medicare |
$210.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$691.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$669.21
|
| Rate for Payer: HFN Commercial |
$691.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.94
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: NAPHCARE Commercial |
$451.15
|
| Rate for Payer: Preferred Network Access Commercial |
$691.77
|
| Rate for Payer: Quartz Beloit One Network |
$368.44
|
| Rate for Payer: Quartz Commercial |
$488.75
|
| Rate for Payer: Quartz Medicare Advantage |
$451.15
|
| Rate for Payer: The Alliance Commercial |
$375.96
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: WPS Commercial |
$556.93
|
|
|
INTRODUCER 7FR
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972040
|
|
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 7FR
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972040
|
|
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 7FR. RDC GUIDING 4037553A
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
2972130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.01 |
| Max. Negotiated Rate |
$1,173.04 |
| Rate for Payer: Aetna Commercial |
$1,147.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.53
|
| Rate for Payer: Aetna Managed Medicare |
$357.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.77
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,173.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$713.53
|
| Rate for Payer: Health EOS Commercial |
$1,134.79
|
| Rate for Payer: HFN Commercial |
$1,173.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$956.28
|
| Rate for Payer: Multiplan Commercial |
$1,020.03
|
| Rate for Payer: NAPHCARE Commercial |
$765.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$624.77
|
| Rate for Payer: Quartz Commercial |
$828.78
|
| Rate for Payer: Quartz Medicare Advantage |
$765.02
|
| Rate for Payer: The Alliance Commercial |
$637.52
|
| Rate for Payer: WEA Trust Commercial |
$701.27
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
INTRODUCER 7FR. RDC GUIDING 4037553A
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
2972130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.77 |
| Max. Negotiated Rate |
$1,173.04 |
| Rate for Payer: Aetna Commercial |
$1,147.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.77
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,173.04
|
| Rate for Payer: Health EOS Commercial |
$1,134.79
|
| Rate for Payer: HFN Commercial |
$1,173.04
|
| Rate for Payer: Multiplan Commercial |
$1,020.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$624.77
|
| Rate for Payer: Quartz Commercial |
$765.02
|
| Rate for Payer: WEA Trust Commercial |
$701.27
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
INTRODUCER 8fr. HS 403-8553H
|
Facility
|
OP
|
$1,188.00
|
|
| Hospital Charge Code |
2972095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
INTRODUCER 8fr. HS 403-8553H
|
Facility
|
IP
|
$1,188.00
|
|
| Hospital Charge Code |
2972095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
INTRODUCER BOUGIE ADULT 9-0212-70
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
2963462
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
INTRODUCER BOUGIE ADULT 9-0212-70
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
2963462
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$81.64
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
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
|
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 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 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 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 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 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 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 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 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: HFN Commercial |
$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: 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 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 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 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
|
|
