|
CATHETER 5cm MICROMEWI
|
Facility
OP
|
$3,408.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2973139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.24 |
| Max. Negotiated Rate |
$3,135.36 |
| Rate for Payer: Aetna Commercial |
$3,067.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,930.88
|
| Rate for Payer: Aetna Managed Medicare |
$954.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,215.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.24
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$3,135.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,907.12
|
| Rate for Payer: Health EOS Commercial |
$3,033.12
|
| Rate for Payer: HFN Commercial |
$3,135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,556.00
|
| Rate for Payer: Multiplan Commercial |
$2,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,044.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,135.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.92
|
| Rate for Payer: Quartz Commercial |
$2,215.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,044.80
|
| Rate for Payer: WEA Trust Commercial |
$1,874.40
|
| Rate for Payer: WPS Commercial |
$2,524.31
|
|
|
CATHETER 5cm MICROMEWI
|
Facility
IP
|
$3,408.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2973139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,669.92 |
| Max. Negotiated Rate |
$3,135.36 |
| Rate for Payer: Aetna Commercial |
$3,067.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,806.24
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$3,135.36
|
| Rate for Payer: Health EOS Commercial |
$3,033.12
|
| Rate for Payer: HFN Commercial |
$3,135.36
|
| Rate for Payer: Multiplan Commercial |
$2,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,044.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,135.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.92
|
| Rate for Payer: Quartz Commercial |
$2,044.80
|
| Rate for Payer: WEA Trust Commercial |
$1,874.40
|
| Rate for Payer: WPS Commercial |
$2,524.31
|
|
|
CATHETER 5 FR. 1M 534-560T
|
Facility
OP
|
$410.00
|
|
| Hospital Charge Code |
2971312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.60
|
| Rate for Payer: Aetna Managed Medicare |
$114.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.44
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$266.50
|
| Rate for Payer: Quartz Medicare Advantage |
$246.00
|
| Rate for Payer: The Alliance Commercial |
$1,640.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
CATHETER 5 FR. 1M 534-560T
|
Facility
IP
|
$410.00
|
|
| Hospital Charge Code |
2971312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$377.20 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$246.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
CATHETER 5FR. CRD 10MM SPACING 401433
|
Facility
IP
|
$4,149.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
2973488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,033.01 |
| Max. Negotiated Rate |
$3,817.08 |
| Rate for Payer: Aetna Commercial |
$3,734.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,198.97
|
| Rate for Payer: Cash Price |
$1,244.70
|
| Rate for Payer: Cigna Commercial |
$3,817.08
|
| Rate for Payer: Health EOS Commercial |
$3,692.61
|
| Rate for Payer: HFN Commercial |
$3,817.08
|
| Rate for Payer: Multiplan Commercial |
$3,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,489.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,817.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,033.01
|
| Rate for Payer: Quartz Commercial |
$2,489.40
|
| Rate for Payer: WEA Trust Commercial |
$2,281.95
|
| Rate for Payer: WPS Commercial |
$3,073.16
|
|
|
CATHETER 5FR. CRD 10MM SPACING 401433
|
Facility
OP
|
$4,149.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
2973488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,161.72 |
| Max. Negotiated Rate |
$3,817.08 |
| Rate for Payer: Aetna Commercial |
$3,734.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,568.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,161.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,696.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,074.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,991.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,198.97
|
| Rate for Payer: Cash Price |
$1,244.70
|
| Rate for Payer: Cigna Commercial |
$3,817.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,321.78
|
| Rate for Payer: Health EOS Commercial |
$3,692.61
|
| Rate for Payer: HFN Commercial |
$3,817.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,111.75
|
| Rate for Payer: Multiplan Commercial |
$3,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,489.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,817.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,033.01
|
| Rate for Payer: Quartz Commercial |
$2,696.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,489.40
|
| Rate for Payer: WEA Trust Commercial |
$2,281.95
|
| Rate for Payer: WPS Commercial |
$3,073.16
|
|
|
CATHETER 5FR EMBOLECTOMY AP4558
|
Facility
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.45 |
| Max. Negotiated Rate |
$1,108.60 |
| Rate for Payer: Aetna Commercial |
$1,084.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.65
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,108.60
|
| Rate for Payer: Health EOS Commercial |
$1,072.45
|
| Rate for Payer: HFN Commercial |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$964.00
|
| Rate for Payer: NAPHCARE Commercial |
$723.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.60
|
| Rate for Payer: Quartz Beloit One Network |
$590.45
|
| Rate for Payer: Quartz Commercial |
$723.00
|
| Rate for Payer: WEA Trust Commercial |
$662.75
|
| Rate for Payer: WPS Commercial |
$892.54
|
|
|
CATHETER 5FR EMBOLECTOMY AP4558
|
Facility
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$1,108.60 |
| Rate for Payer: Aetna Commercial |
$1,084.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.30
|
| Rate for Payer: Aetna Managed Medicare |
$337.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.65
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,108.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$674.32
|
| Rate for Payer: Health EOS Commercial |
$1,072.45
|
| Rate for Payer: HFN Commercial |
$1,108.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.75
|
| Rate for Payer: Multiplan Commercial |
$964.00
|
| Rate for Payer: NAPHCARE Commercial |
$723.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.60
|
| Rate for Payer: Quartz Beloit One Network |
$590.45
|
| Rate for Payer: Quartz Commercial |
$783.25
|
| Rate for Payer: Quartz Medicare Advantage |
$723.00
|
| Rate for Payer: WEA Trust Commercial |
$662.75
|
| Rate for Payer: WPS Commercial |
$892.54
|
|
|
CATHETER 5 FR. MPA 2 #534-542T
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$377.20 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$246.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
CATHETER 5 FR. MPA 2 #534-542T
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$377.20 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.60
|
| Rate for Payer: Aetna Managed Medicare |
$114.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.44
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$266.50
|
| Rate for Payer: Quartz Medicare Advantage |
$246.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
CATHETER 6FR.145 DEG. ANG. 534652S
|
Facility
IP
|
$535.00
|
|
| Hospital Charge Code |
2972767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR.145 DEG. ANG. 534652S
|
Facility
OP
|
$535.00
|
|
| Hospital Charge Code |
2972767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR. ALII 534-646T
|
Facility
OP
|
$497.00
|
|
| Hospital Charge Code |
2972693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.16 |
| Max. Negotiated Rate |
$1,988.00 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.12
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.75
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$298.20
|
| Rate for Payer: The Alliance Commercial |
$1,988.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
CATHETER 6FR. ALII 534-646T
|
Facility
IP
|
$497.00
|
|
| Hospital Charge Code |
2972693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
CATHETER 6fr. ALIII ST 532-647
|
Facility
OP
|
$482.00
|
|
| Hospital Charge Code |
2971202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$1,928.00 |
| Rate for Payer: Aetna Commercial |
$433.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.52
|
| Rate for Payer: Aetna Managed Medicare |
$134.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$313.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$231.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.46
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$443.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.73
|
| Rate for Payer: Health EOS Commercial |
$428.98
|
| Rate for Payer: HFN Commercial |
$443.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.50
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: NAPHCARE Commercial |
$289.20
|
| Rate for Payer: Preferred Network Access Commercial |
$443.44
|
| Rate for Payer: Quartz Beloit One Network |
$236.18
|
| Rate for Payer: Quartz Commercial |
$313.30
|
| Rate for Payer: Quartz Medicare Advantage |
$289.20
|
| Rate for Payer: The Alliance Commercial |
$1,928.00
|
| Rate for Payer: WEA Trust Commercial |
$265.10
|
| Rate for Payer: WPS Commercial |
$357.02
|
|
|
CATHETER 6fr. ALIII ST 532-647
|
Facility
IP
|
$482.00
|
|
| Hospital Charge Code |
2971202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$443.44 |
| Rate for Payer: Aetna Commercial |
$433.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.46
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$443.44
|
| Rate for Payer: Health EOS Commercial |
$428.98
|
| Rate for Payer: HFN Commercial |
$443.44
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: NAPHCARE Commercial |
$289.20
|
| Rate for Payer: Preferred Network Access Commercial |
$443.44
|
| Rate for Payer: Quartz Beloit One Network |
$236.18
|
| Rate for Payer: Quartz Commercial |
$289.20
|
| Rate for Payer: WEA Trust Commercial |
$265.10
|
| Rate for Payer: WPS Commercial |
$357.02
|
|
|
CATHETER 6 FR. ALI ST. 532645
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6 FR. ALI ST. 532645
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR. AR MOD 534648T
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR. AR MOD 534648T
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR EMBOLECTOMY AP4568
|
Facility
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$1,108.60 |
| Rate for Payer: Aetna Commercial |
$1,084.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.30
|
| Rate for Payer: Aetna Managed Medicare |
$337.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.65
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,108.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$674.32
|
| Rate for Payer: Health EOS Commercial |
$1,072.45
|
| Rate for Payer: HFN Commercial |
$1,108.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.75
|
| Rate for Payer: Multiplan Commercial |
$964.00
|
| Rate for Payer: NAPHCARE Commercial |
$723.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.60
|
| Rate for Payer: Quartz Beloit One Network |
$590.45
|
| Rate for Payer: Quartz Commercial |
$783.25
|
| Rate for Payer: Quartz Medicare Advantage |
$723.00
|
| Rate for Payer: WEA Trust Commercial |
$662.75
|
| Rate for Payer: WPS Commercial |
$892.54
|
|
|
CATHETER 6FR EMBOLECTOMY AP4568
|
Facility
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.45 |
| Max. Negotiated Rate |
$1,108.60 |
| Rate for Payer: Aetna Commercial |
$1,084.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.65
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,108.60
|
| Rate for Payer: Health EOS Commercial |
$1,072.45
|
| Rate for Payer: HFN Commercial |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$964.00
|
| Rate for Payer: NAPHCARE Commercial |
$723.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.60
|
| Rate for Payer: Quartz Beloit One Network |
$590.45
|
| Rate for Payer: Quartz Commercial |
$723.00
|
| Rate for Payer: WEA Trust Commercial |
$662.75
|
| Rate for Payer: WPS Commercial |
$892.54
|
|
|
CATHETER 6FR IM 534660T
|
Facility
OP
|
$535.00
|
|
| Hospital Charge Code |
2971394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR IM 534660T
|
Facility
IP
|
$535.00
|
|
| Hospital Charge Code |
2971394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER 6FR.JL5 534622T
|
Facility
OP
|
$535.00
|
|
| Hospital Charge Code |
2972768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
