|
CATHETER ARROW-KARLAN LAP CHOLANGIOGRAPHY BALLOON CS-01700
|
Facility
OP
|
$1,305.00
|
|
| Hospital Charge Code |
2962935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$5,220.00 |
| Rate for Payer: Aetna Commercial |
$1,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.30
|
| Rate for Payer: Aetna Managed Medicare |
$365.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.65
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,200.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.28
|
| Rate for Payer: Health EOS Commercial |
$1,161.45
|
| Rate for Payer: HFN Commercial |
$1,200.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.75
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: NAPHCARE Commercial |
$783.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.60
|
| Rate for Payer: Quartz Beloit One Network |
$639.45
|
| Rate for Payer: Quartz Commercial |
$848.25
|
| Rate for Payer: Quartz Medicare Advantage |
$783.00
|
| Rate for Payer: The Alliance Commercial |
$5,220.00
|
| Rate for Payer: WEA Trust Commercial |
$717.75
|
| Rate for Payer: WPS Commercial |
$966.61
|
|
|
CATHETER ASPIRATION 2.3mm 240cm 2181
|
Facility
OP
|
$514.00
|
|
| Hospital Charge Code |
4508662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CATHETER ASPIRATION 2.3mm 240cm 2181
|
Facility
IP
|
$514.00
|
|
| Hospital Charge Code |
4508662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CATHETER ATTAIN
|
Facility
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN
|
Facility
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN STRAIGHT
|
Facility
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN STRAIGHT
|
Facility
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN VENOGRAM 6215 KIT
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
CATHETER ATTAIN VENOGRAM 6215 KIT
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
CATHETER BERN IMAGER II 5FR X 40CM M0064005030
|
Facility
IP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER BERN IMAGER II 5FR X 40CM M0064005030
|
Facility
OP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER BERN IMAGER II 5FR X 65CM M0064003030
|
Facility
OP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER BERN IMAGER II 5FR X 65CM M0064003030
|
Facility
IP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER CABLE
|
Facility
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER CABLE
|
Facility
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER CAP #418027
|
Facility
IP
|
$3.00
|
|
| Hospital Charge Code |
2970155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
CATHETER CAP #418027
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
2970155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
CATHETER CLOSUREFAST 3CM CF7-3-60
|
Facility
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$7,176.00 |
| Rate for Payer: Aetna Commercial |
$7,020.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,708.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,184.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,070.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,900.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,176.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,364.88
|
| Rate for Payer: Health EOS Commercial |
$6,942.00
|
| Rate for Payer: HFN Commercial |
$7,176.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$6,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,176.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,822.00
|
| Rate for Payer: Quartz Commercial |
$5,070.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,680.00
|
| Rate for Payer: WEA Trust Commercial |
$4,290.00
|
| Rate for Payer: WPS Commercial |
$5,777.46
|
|
|
CATHETER CLOSUREFAST 3CM CF7-3-60
|
Facility
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,822.00 |
| Max. Negotiated Rate |
$7,176.00 |
| Rate for Payer: Aetna Commercial |
$7,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,176.00
|
| Rate for Payer: Health EOS Commercial |
$6,942.00
|
| Rate for Payer: HFN Commercial |
$7,176.00
|
| Rate for Payer: Multiplan Commercial |
$6,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,176.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,822.00
|
| Rate for Payer: Quartz Commercial |
$4,680.00
|
| Rate for Payer: WEA Trust Commercial |
$4,290.00
|
| Rate for Payer: WPS Commercial |
$5,777.46
|
|
|
CATHETER CLOSUREFAST 7FR 100CM CF7-7-100
|
Facility
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,822.00 |
| Max. Negotiated Rate |
$7,176.00 |
| Rate for Payer: Aetna Commercial |
$7,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,176.00
|
| Rate for Payer: Health EOS Commercial |
$6,942.00
|
| Rate for Payer: HFN Commercial |
$7,176.00
|
| Rate for Payer: Multiplan Commercial |
$6,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,176.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,822.00
|
| Rate for Payer: Quartz Commercial |
$4,680.00
|
| Rate for Payer: WEA Trust Commercial |
$4,290.00
|
| Rate for Payer: WPS Commercial |
$5,777.46
|
|
|
CATHETER CLOSUREFAST 7FR 100CM CF7-7-100
|
Facility
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$7,176.00 |
| Rate for Payer: Aetna Commercial |
$7,020.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,708.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,184.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,070.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,900.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,176.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,364.88
|
| Rate for Payer: Health EOS Commercial |
$6,942.00
|
| Rate for Payer: HFN Commercial |
$7,176.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$6,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,176.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,822.00
|
| Rate for Payer: Quartz Commercial |
$5,070.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,680.00
|
| Rate for Payer: WEA Trust Commercial |
$4,290.00
|
| Rate for Payer: WPS Commercial |
$5,777.46
|
|
|
CATHETER CLOSUREFAST 7FR 60CM CF7-7-60
|
Facility
OP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,268.28 |
| Max. Negotiated Rate |
$7,452.92 |
| Rate for Payer: Aetna Commercial |
$7,290.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,966.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,268.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,265.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,050.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,888.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,293.53
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,452.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,533.32
|
| Rate for Payer: Health EOS Commercial |
$7,209.89
|
| Rate for Payer: HFN Commercial |
$7,452.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,075.75
|
| Rate for Payer: Multiplan Commercial |
$6,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,452.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,969.49
|
| Rate for Payer: Quartz Commercial |
$5,265.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,860.60
|
| Rate for Payer: WEA Trust Commercial |
$4,455.55
|
| Rate for Payer: WPS Commercial |
$6,000.41
|
|
|
CATHETER CLOSUREFAST 7FR 60CM CF7-7-60
|
Facility
IP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,969.49 |
| Max. Negotiated Rate |
$7,452.92 |
| Rate for Payer: Aetna Commercial |
$7,290.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,293.53
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,452.92
|
| Rate for Payer: Health EOS Commercial |
$7,209.89
|
| Rate for Payer: HFN Commercial |
$7,452.92
|
| Rate for Payer: Multiplan Commercial |
$6,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,452.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,969.49
|
| Rate for Payer: Quartz Commercial |
$4,860.60
|
| Rate for Payer: WEA Trust Commercial |
$4,455.55
|
| Rate for Payer: WPS Commercial |
$6,000.41
|
|
|
CATHETER CONE TIP 10FR URETERAL G14665
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$84.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
CATHETER CONE TIP 10FR URETERAL G14665
|
Facility
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
