|
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: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| 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 |
$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 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 |
$4,820.00 |
| 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: The Alliance Commercial |
$4,820.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$1,036.30
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| 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 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. JL3.5 #534-618T
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Aetna Managed Medicare |
$37.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.99
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$87.10
|
| Rate for Payer: Quartz Medicare Advantage |
$80.40
|
| Rate for Payer: The Alliance Commercial |
$536.00
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
CATHETER 6FR. JL3.5 #534-618T
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$80.40
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
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
|
|
|
CATHETER 6FR.JL5 534622T
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2972768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| 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 JL6 534624T
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2972694
|
|
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 JL6 534624T
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2972694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| 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.JL7
|
Facility
|
OP
|
$528.00
|
|
| Hospital Charge Code |
2971374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$475.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.08
|
| Rate for Payer: Aetna Managed Medicare |
$147.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$343.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$253.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$279.84
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$485.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.47
|
| Rate for Payer: Health EOS Commercial |
$469.92
|
| Rate for Payer: HFN Commercial |
$485.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$422.40
|
| Rate for Payer: NAPHCARE Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$485.76
|
| Rate for Payer: Quartz Beloit One Network |
$258.72
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: Quartz Medicare Advantage |
$316.80
|
| Rate for Payer: The Alliance Commercial |
$2,112.00
|
| Rate for Payer: WEA Trust Commercial |
$290.40
|
| Rate for Payer: WPS Commercial |
$391.09
|
|
|
CATHETER 6fr.JL7
|
Facility
|
IP
|
$528.00
|
|
| Hospital Charge Code |
2971374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$475.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$279.84
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$485.76
|
| Rate for Payer: Health EOS Commercial |
$469.92
|
| Rate for Payer: HFN Commercial |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$422.40
|
| Rate for Payer: NAPHCARE Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$485.76
|
| Rate for Payer: Quartz Beloit One Network |
$258.72
|
| Rate for Payer: Quartz Commercial |
$316.80
|
| Rate for Payer: WEA Trust Commercial |
$290.40
|
| Rate for Payer: WPS Commercial |
$391.09
|
|
|
CATHETER 6FR. JR4 534621T
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972766
|
|
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. JR4 534621T
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| 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 6 FR. LCB 533672
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$74.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$159.00
|
| Rate for Payer: The Alliance Commercial |
$1,060.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
CATHETER 6 FR. LCB 533672
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
CATHETER 6FR. RCB 533-670T
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
2970776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.46 |
| Max. Negotiated Rate |
$233.68 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.62
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$233.68
|
| Rate for Payer: Health EOS Commercial |
$226.06
|
| Rate for Payer: HFN Commercial |
$233.68
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: NAPHCARE Commercial |
$152.40
|
| Rate for Payer: Preferred Network Access Commercial |
$233.68
|
| Rate for Payer: Quartz Beloit One Network |
$124.46
|
| Rate for Payer: Quartz Commercial |
$152.40
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
CATHETER 6FR. RCB 533-670T
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
2970776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Aetna Managed Medicare |
$71.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.62
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$233.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.14
|
| Rate for Payer: Health EOS Commercial |
$226.06
|
| Rate for Payer: HFN Commercial |
$233.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.50
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: NAPHCARE Commercial |
$152.40
|
| Rate for Payer: Preferred Network Access Commercial |
$233.68
|
| Rate for Payer: Quartz Beloit One Network |
$124.46
|
| Rate for Payer: Quartz Commercial |
$165.10
|
| Rate for Payer: Quartz Medicare Advantage |
$152.40
|
| Rate for Payer: The Alliance Commercial |
$1,016.00
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
CATHETER 6FR. RENAL (RDC-A2) 455689
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
2971252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.72 |
| Max. Negotiated Rate |
$1,796.00 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Aetna Managed Medicare |
$125.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.97
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$413.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.26
|
| Rate for Payer: Health EOS Commercial |
$399.61
|
| Rate for Payer: HFN Commercial |
$413.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.75
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: NAPHCARE Commercial |
$269.40
|
| Rate for Payer: Preferred Network Access Commercial |
$413.08
|
| Rate for Payer: Quartz Beloit One Network |
$220.01
|
| Rate for Payer: Quartz Commercial |
$291.85
|
| Rate for Payer: Quartz Medicare Advantage |
$269.40
|
| Rate for Payer: The Alliance Commercial |
$1,796.00
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
CATHETER 6FR. RENAL (RDC-A2) 455689
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2971252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.01 |
| Max. Negotiated Rate |
$413.08 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.97
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$413.08
|
| Rate for Payer: Health EOS Commercial |
$399.61
|
| Rate for Payer: HFN Commercial |
$413.08
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: NAPHCARE Commercial |
$269.40
|
| Rate for Payer: Preferred Network Access Commercial |
$413.08
|
| Rate for Payer: Quartz Beloit One Network |
$220.01
|
| Rate for Payer: Quartz Commercial |
$269.40
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
CATHETER 72 HOUR TRACH CARE
|
Facility
|
IP
|
$386.00
|
|
| Hospital Charge Code |
2973456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
CATHETER 72 HOUR TRACH CARE
|
Facility
|
OP
|
$386.00
|
|
| Hospital Charge Code |
2973456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$1,544.00 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$108.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.01
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$231.60
|
| Rate for Payer: The Alliance Commercial |
$1,544.00
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
CATHETER 7FR 1M SH GUIDE 778-191-00
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972615
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| 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
|
|
