|
CATHETER CONE TIP12FR URETERAL 024607
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964974
|
|
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 TIP12FR URETERAL 024607
|
Facility
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964974
|
|
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
|
|
|
CATHETER CONE TIP 5FR URETERAL M0064002110
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER CONE TIP 5FR URETERAL M0064002110
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER CONE TIP 6FR X 70CM 10FR TIP URETERAL M0064002121
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4519310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER CONE TIP 6FR X 70CM 10FR TIP URETERAL M0064002121
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4519310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER CONE TIP 7FR X 70CM URETERAL M0064002130
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER CONE TIP 7FR X 70CM URETERAL M0064002130
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER CONE TIP 8FR URETERAL G14663
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2963868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.36 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$59.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
CATHETER CONE TIP 8FR URETERAL G14663
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2963868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
CATHETER CROSSER CTO
|
Facility
IP
|
$13,392.00
|
|
| Hospital Charge Code |
2973903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,562.08 |
| Max. Negotiated Rate |
$12,320.64 |
| Rate for Payer: Aetna Commercial |
$12,052.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,097.76
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Cigna Commercial |
$12,320.64
|
| Rate for Payer: Health EOS Commercial |
$11,918.88
|
| Rate for Payer: HFN Commercial |
$12,320.64
|
| Rate for Payer: Multiplan Commercial |
$10,713.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,035.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,320.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,562.08
|
| Rate for Payer: Quartz Commercial |
$8,035.20
|
| Rate for Payer: WEA Trust Commercial |
$7,365.60
|
| Rate for Payer: WPS Commercial |
$9,919.45
|
|
|
CATHETER CROSSER CTO
|
Facility
OP
|
$13,392.00
|
|
| Hospital Charge Code |
2973903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,749.76 |
| Max. Negotiated Rate |
$53,568.00 |
| Rate for Payer: Aetna Commercial |
$12,052.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,517.12
|
| Rate for Payer: Aetna Managed Medicare |
$3,749.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,704.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,696.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,428.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,097.76
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Cigna Commercial |
$12,320.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,494.16
|
| Rate for Payer: Health EOS Commercial |
$11,918.88
|
| Rate for Payer: HFN Commercial |
$12,320.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,044.00
|
| Rate for Payer: Multiplan Commercial |
$10,713.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,035.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,320.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,562.08
|
| Rate for Payer: Quartz Commercial |
$8,704.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,035.20
|
| Rate for Payer: The Alliance Commercial |
$53,568.00
|
| Rate for Payer: WEA Trust Commercial |
$7,365.60
|
| Rate for Payer: WPS Commercial |
$9,919.45
|
|
|
CATHETER CS & HRA 20 POLE
|
Facility
OP
|
$6,397.00
|
|
| Hospital Charge Code |
2973708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.16 |
| Max. Negotiated Rate |
$25,588.00 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,791.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,158.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,198.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,070.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,797.75
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,838.20
|
| Rate for Payer: The Alliance Commercial |
$25,588.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
CATHETER CS & HRA 20 POLE
|
Facility
IP
|
$6,397.00
|
|
| Hospital Charge Code |
2973708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
CATHETER CURL 62cm 8817278006
|
Facility
OP
|
$1,863.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
2973652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.64 |
| Max. Negotiated Rate |
$1,713.96 |
| Rate for Payer: Aetna Commercial |
$1,676.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.18
|
| Rate for Payer: Aetna Managed Medicare |
$521.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.39
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna Commercial |
$1,713.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.53
|
| Rate for Payer: Health EOS Commercial |
$1,658.07
|
| Rate for Payer: HFN Commercial |
$1,713.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.25
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.96
|
| Rate for Payer: Quartz Beloit One Network |
$912.87
|
| Rate for Payer: Quartz Commercial |
$1,210.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,117.80
|
| Rate for Payer: WEA Trust Commercial |
$1,024.65
|
| Rate for Payer: WPS Commercial |
$1,379.92
|
|
|
CATHETER CURL 62cm 8817278006
|
Facility
IP
|
$1,863.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
2973652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.87 |
| Max. Negotiated Rate |
$1,713.96 |
| Rate for Payer: Aetna Commercial |
$1,676.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.39
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna Commercial |
$1,713.96
|
| Rate for Payer: Health EOS Commercial |
$1,658.07
|
| Rate for Payer: HFN Commercial |
$1,713.96
|
| Rate for Payer: Multiplan Commercial |
$1,490.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.96
|
| Rate for Payer: Quartz Beloit One Network |
$912.87
|
| Rate for Payer: Quartz Commercial |
$1,117.80
|
| Rate for Payer: WEA Trust Commercial |
$1,024.65
|
| Rate for Payer: WPS Commercial |
$1,379.92
|
|
|
CATHETER CURVE ABLATION LG.
|
Facility
OP
|
$6,316.00
|
|
| Hospital Charge Code |
2973761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,768.48 |
| Max. Negotiated Rate |
$25,264.00 |
| Rate for Payer: Aetna Commercial |
$5,684.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,431.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,768.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,105.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,158.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,031.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,347.48
|
| Rate for Payer: Cash Price |
$1,894.80
|
| Rate for Payer: Cigna Commercial |
$5,810.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,534.43
|
| Rate for Payer: Health EOS Commercial |
$5,621.24
|
| Rate for Payer: HFN Commercial |
$5,810.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,737.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,789.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,810.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,094.84
|
| Rate for Payer: Quartz Commercial |
$4,105.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,789.60
|
| Rate for Payer: The Alliance Commercial |
$25,264.00
|
| Rate for Payer: WEA Trust Commercial |
$3,473.80
|
| Rate for Payer: WPS Commercial |
$4,678.26
|
|
|
CATHETER CURVE ABLATION LG.
|
Facility
IP
|
$6,316.00
|
|
| Hospital Charge Code |
2973761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,094.84 |
| Max. Negotiated Rate |
$5,810.72 |
| Rate for Payer: Aetna Commercial |
$5,684.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,347.48
|
| Rate for Payer: Cash Price |
$1,894.80
|
| Rate for Payer: Cigna Commercial |
$5,810.72
|
| Rate for Payer: Health EOS Commercial |
$5,621.24
|
| Rate for Payer: HFN Commercial |
$5,810.72
|
| Rate for Payer: Multiplan Commercial |
$5,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,789.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,810.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,094.84
|
| Rate for Payer: Quartz Commercial |
$3,789.60
|
| Rate for Payer: WEA Trust Commercial |
$3,473.80
|
| Rate for Payer: WPS Commercial |
$4,678.26
|
|
|
CATHETER DBD PACING SWAN GANZ W/O HEPARIN
|
Facility
IP
|
$4,413.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962945
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,162.37 |
| Max. Negotiated Rate |
$4,059.96 |
| Rate for Payer: Aetna Commercial |
$3,971.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,338.89
|
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Cigna Commercial |
$4,059.96
|
| Rate for Payer: Health EOS Commercial |
$3,927.57
|
| Rate for Payer: HFN Commercial |
$4,059.96
|
| Rate for Payer: Multiplan Commercial |
$3,530.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,647.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,059.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,162.37
|
| Rate for Payer: Quartz Commercial |
$2,647.80
|
| Rate for Payer: WEA Trust Commercial |
$2,427.15
|
| Rate for Payer: WPS Commercial |
$3,268.71
|
|
|
CATHETER DBD PACING SWAN GANZ W/O HEPARIN
|
Facility
OP
|
$4,413.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962945
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,235.64 |
| Max. Negotiated Rate |
$4,059.96 |
| Rate for Payer: Aetna Commercial |
$3,971.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,795.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,235.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,868.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,118.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,338.89
|
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Cigna Commercial |
$4,059.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,469.51
|
| Rate for Payer: Health EOS Commercial |
$3,927.57
|
| Rate for Payer: HFN Commercial |
$4,059.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,309.75
|
| Rate for Payer: Multiplan Commercial |
$3,530.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,647.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,059.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,162.37
|
| Rate for Payer: Quartz Commercial |
$2,868.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,647.80
|
| Rate for Payer: WEA Trust Commercial |
$2,427.15
|
| Rate for Payer: WPS Commercial |
$3,268.71
|
|
|
CATHETER DRAINAGE 12fr ANGIOTE #756512025
|
Facility
IP
|
$1,666.00
|
|
| Hospital Charge Code |
2973596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.34 |
| Max. Negotiated Rate |
$1,532.72 |
| Rate for Payer: Aetna Commercial |
$1,499.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$882.98
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$1,532.72
|
| Rate for Payer: Health EOS Commercial |
$1,482.74
|
| Rate for Payer: HFN Commercial |
$1,532.72
|
| Rate for Payer: Multiplan Commercial |
$1,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$999.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.72
|
| Rate for Payer: Quartz Beloit One Network |
$816.34
|
| Rate for Payer: Quartz Commercial |
$999.60
|
| Rate for Payer: WEA Trust Commercial |
$916.30
|
| Rate for Payer: WPS Commercial |
$1,234.01
|
|
|
CATHETER DRAINAGE 12fr ANGIOTE #756512025
|
Facility
OP
|
$1,666.00
|
|
| Hospital Charge Code |
2973596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.48 |
| Max. Negotiated Rate |
$6,664.00 |
| Rate for Payer: Aetna Commercial |
$1,499.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.76
|
| Rate for Payer: Aetna Managed Medicare |
$466.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,082.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$833.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$799.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$882.98
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$1,532.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.29
|
| Rate for Payer: Health EOS Commercial |
$1,482.74
|
| Rate for Payer: HFN Commercial |
$1,532.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.50
|
| Rate for Payer: Multiplan Commercial |
$1,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$999.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.72
|
| Rate for Payer: Quartz Beloit One Network |
$816.34
|
| Rate for Payer: Quartz Commercial |
$1,082.90
|
| Rate for Payer: Quartz Medicare Advantage |
$999.60
|
| Rate for Payer: The Alliance Commercial |
$6,664.00
|
| Rate for Payer: WEA Trust Commercial |
$916.30
|
| Rate for Payer: WPS Commercial |
$1,234.01
|
|
|
CATHETER DUAL SENSOR 7F W/FILL #T-DOC-7FD
|
Facility
IP
|
$740.00
|
|
| Hospital Charge Code |
2973496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.60 |
| Max. Negotiated Rate |
$680.80 |
| Rate for Payer: Aetna Commercial |
$666.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$392.20
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$680.80
|
| Rate for Payer: Health EOS Commercial |
$658.60
|
| Rate for Payer: HFN Commercial |
$680.80
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: NAPHCARE Commercial |
$444.00
|
| Rate for Payer: Preferred Network Access Commercial |
$680.80
|
| Rate for Payer: Quartz Beloit One Network |
$362.60
|
| Rate for Payer: Quartz Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$407.00
|
| Rate for Payer: WPS Commercial |
$548.12
|
|
|
CATHETER DUAL SENSOR 7F W/FILL #T-DOC-7FD
|
Facility
OP
|
$740.00
|
|
| Hospital Charge Code |
2973496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$2,960.00 |
| Rate for Payer: Aetna Commercial |
$666.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$636.40
|
| Rate for Payer: Aetna Managed Medicare |
$207.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$481.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$370.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$355.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$392.20
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$680.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$414.10
|
| Rate for Payer: Health EOS Commercial |
$658.60
|
| Rate for Payer: HFN Commercial |
$680.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$555.00
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: NAPHCARE Commercial |
$444.00
|
| Rate for Payer: Preferred Network Access Commercial |
$680.80
|
| Rate for Payer: Quartz Beloit One Network |
$362.60
|
| Rate for Payer: Quartz Commercial |
$481.00
|
| Rate for Payer: Quartz Medicare Advantage |
$444.00
|
| Rate for Payer: The Alliance Commercial |
$2,960.00
|
| Rate for Payer: WEA Trust Commercial |
$407.00
|
| Rate for Payer: WPS Commercial |
$548.12
|
|
|
CATHETER EBU GUIDE 3.0 LA6EBU30
|
Facility
OP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.88 |
| Max. Negotiated Rate |
$893.32 |
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Aetna Managed Medicare |
$271.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$485.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.63
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$893.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.37
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.25
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$631.15
|
| Rate for Payer: Quartz Medicare Advantage |
$582.60
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
