|
CATHETER GUIDE JR4 8FR 588-830
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972607
|
|
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 GUIDE SLITTER
|
Facility
OP
|
$610.00
|
|
| Hospital Charge Code |
2971460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
CATHETER GUIDE SLITTER
|
Facility
IP
|
$610.00
|
|
| Hospital Charge Code |
2971460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
CATHETER GUIDEZILLA GUIDE 39242-1505
|
Facility
OP
|
$5,077.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3331522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.56 |
| Max. Negotiated Rate |
$4,670.84 |
| Rate for Payer: Aetna Commercial |
$4,569.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,366.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,421.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,300.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,538.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,436.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,690.81
|
| Rate for Payer: Cash Price |
$1,523.10
|
| Rate for Payer: Cigna Commercial |
$4,670.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,841.09
|
| Rate for Payer: Health EOS Commercial |
$4,518.53
|
| Rate for Payer: HFN Commercial |
$4,670.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,807.75
|
| Rate for Payer: Multiplan Commercial |
$4,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,046.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,670.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,487.73
|
| Rate for Payer: Quartz Commercial |
$3,300.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,792.35
|
| Rate for Payer: WPS Commercial |
$3,760.53
|
|
|
CATHETER GUIDEZILLA GUIDE 39242-1505
|
Facility
IP
|
$5,077.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3331522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,487.73 |
| Max. Negotiated Rate |
$4,670.84 |
| Rate for Payer: Aetna Commercial |
$4,569.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,690.81
|
| Rate for Payer: Cash Price |
$1,523.10
|
| Rate for Payer: Cigna Commercial |
$4,670.84
|
| Rate for Payer: Health EOS Commercial |
$4,518.53
|
| Rate for Payer: HFN Commercial |
$4,670.84
|
| Rate for Payer: Multiplan Commercial |
$4,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,046.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,670.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,487.73
|
| Rate for Payer: Quartz Commercial |
$3,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,792.35
|
| Rate for Payer: WPS Commercial |
$3,760.53
|
|
|
CATHETER GUIDING 7fr HS 77827855
|
Facility
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.36 |
| Max. Negotiated Rate |
$1,713.04 |
| Rate for Payer: Aetna Commercial |
$1,675.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.32
|
| Rate for Payer: Aetna Managed Medicare |
$521.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.86
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,713.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.98
|
| Rate for Payer: Health EOS Commercial |
$1,657.18
|
| Rate for Payer: HFN Commercial |
$1,713.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.50
|
| Rate for Payer: Multiplan Commercial |
$1,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.04
|
| Rate for Payer: Quartz Beloit One Network |
$912.38
|
| Rate for Payer: Quartz Commercial |
$1,210.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,117.20
|
| Rate for Payer: WEA Trust Commercial |
$1,024.10
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
CATHETER GUIDING 7fr HS 77827855
|
Facility
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$912.38 |
| Max. Negotiated Rate |
$1,713.04 |
| Rate for Payer: Aetna Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.86
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,713.04
|
| Rate for Payer: Health EOS Commercial |
$1,657.18
|
| Rate for Payer: HFN Commercial |
$1,713.04
|
| Rate for Payer: Multiplan Commercial |
$1,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.04
|
| Rate for Payer: Quartz Beloit One Network |
$912.38
|
| Rate for Payer: Quartz Commercial |
$1,117.20
|
| Rate for Payer: WEA Trust Commercial |
$1,024.10
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
CATHETER GUIDING 8FR. HS 588841P
|
Facility
IP
|
$1,303.00
|
|
| Hospital Charge Code |
2972161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.47 |
| Max. Negotiated Rate |
$1,198.76 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$781.80
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
CATHETER GUIDING 8FR. HS 588841P
|
Facility
OP
|
$1,303.00
|
|
| Hospital Charge Code |
2972161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.84 |
| Max. Negotiated Rate |
$5,212.00 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Aetna Managed Medicare |
$364.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$625.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$729.16
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.25
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$846.95
|
| Rate for Payer: Quartz Medicare Advantage |
$781.80
|
| Rate for Payer: The Alliance Commercial |
$5,212.00
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
CATHETER HALO EXPRESS RFA BALLOON 64082
|
Facility
IP
|
$1,368.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
5106627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$1,258.56 |
| Rate for Payer: Aetna Commercial |
$1,231.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$725.04
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna Commercial |
$1,258.56
|
| Rate for Payer: Health EOS Commercial |
$1,217.52
|
| Rate for Payer: HFN Commercial |
$1,258.56
|
| Rate for Payer: Multiplan Commercial |
$1,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$820.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,258.56
|
| Rate for Payer: Quartz Beloit One Network |
$670.32
|
| Rate for Payer: Quartz Commercial |
$820.80
|
| Rate for Payer: WEA Trust Commercial |
$752.40
|
| Rate for Payer: WPS Commercial |
$1,013.28
|
|
|
CATHETER HALO EXPRESS RFA BALLOON 64082
|
Facility
OP
|
$1,368.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
5106627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$383.04 |
| Max. Negotiated Rate |
$1,258.56 |
| Rate for Payer: Aetna Commercial |
$1,231.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,176.48
|
| Rate for Payer: Aetna Managed Medicare |
$383.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$889.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$684.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$656.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$725.04
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna Commercial |
$1,258.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.53
|
| Rate for Payer: Health EOS Commercial |
$1,217.52
|
| Rate for Payer: HFN Commercial |
$1,258.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,026.00
|
| Rate for Payer: Multiplan Commercial |
$1,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$820.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,258.56
|
| Rate for Payer: Quartz Beloit One Network |
$670.32
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: Quartz Medicare Advantage |
$820.80
|
| Rate for Payer: WEA Trust Commercial |
$752.40
|
| Rate for Payer: WPS Commercial |
$1,013.28
|
|
|
CATHETER HALO RFA CHANNEL TTS-1100
|
Facility
IP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4147208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,654.51 |
| Max. Negotiated Rate |
$8,739.08 |
| Rate for Payer: Aetna Commercial |
$8,549.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,034.47
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$8,739.08
|
| Rate for Payer: Health EOS Commercial |
$8,454.11
|
| Rate for Payer: HFN Commercial |
$8,739.08
|
| Rate for Payer: Multiplan Commercial |
$7,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,699.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,739.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,654.51
|
| Rate for Payer: Quartz Commercial |
$5,699.40
|
| Rate for Payer: WEA Trust Commercial |
$5,224.45
|
| Rate for Payer: WPS Commercial |
$7,035.91
|
|
|
CATHETER HALO RFA CHANNEL TTS-1100
|
Facility
OP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4147208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,659.72 |
| Max. Negotiated Rate |
$8,739.08 |
| Rate for Payer: Aetna Commercial |
$8,549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,169.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,659.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,174.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,749.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,559.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,034.47
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$8,739.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,315.64
|
| Rate for Payer: Health EOS Commercial |
$8,454.11
|
| Rate for Payer: HFN Commercial |
$8,739.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,124.25
|
| Rate for Payer: Multiplan Commercial |
$7,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,699.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,739.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,654.51
|
| Rate for Payer: Quartz Commercial |
$6,174.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,699.40
|
| Rate for Payer: WEA Trust Commercial |
$5,224.45
|
| Rate for Payer: WPS Commercial |
$7,035.91
|
|
|
CATHETER - INDWELLING/CONTINUOUS* 51702
|
Facility
OP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6031631
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$269.25
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
CATHETER - INDWELLING/CONTINUOUS* 51702
|
Facility
IP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6031631
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
CATHETER INDWELLING SLIT SET 295-6
|
Facility
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2962861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.28 |
| Max. Negotiated Rate |
$4,604.00 |
| Rate for Payer: Aetna Commercial |
$1,035.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.86
|
| Rate for Payer: Aetna Managed Medicare |
$322.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$575.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.03
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,058.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.10
|
| Rate for Payer: Health EOS Commercial |
$1,024.39
|
| Rate for Payer: HFN Commercial |
$1,058.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$863.25
|
| Rate for Payer: Multiplan Commercial |
$920.80
|
| Rate for Payer: NAPHCARE Commercial |
$690.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.92
|
| Rate for Payer: Quartz Beloit One Network |
$563.99
|
| Rate for Payer: Quartz Commercial |
$748.15
|
| Rate for Payer: Quartz Medicare Advantage |
$690.60
|
| Rate for Payer: The Alliance Commercial |
$4,604.00
|
| Rate for Payer: WEA Trust Commercial |
$633.05
|
| Rate for Payer: WPS Commercial |
$852.55
|
|
|
CATHETER INDWELLING SLIT SET 295-6
|
Facility
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2962861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.99 |
| Max. Negotiated Rate |
$1,058.92 |
| Rate for Payer: Aetna Commercial |
$1,035.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.03
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,058.92
|
| Rate for Payer: Health EOS Commercial |
$1,024.39
|
| Rate for Payer: HFN Commercial |
$1,058.92
|
| Rate for Payer: Multiplan Commercial |
$920.80
|
| Rate for Payer: NAPHCARE Commercial |
$690.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.92
|
| Rate for Payer: Quartz Beloit One Network |
$563.99
|
| Rate for Payer: Quartz Commercial |
$690.60
|
| Rate for Payer: WEA Trust Commercial |
$633.05
|
| Rate for Payer: WPS Commercial |
$852.55
|
|
|
CATHETER INFUSION 5FR 41058-01 135CM X 30CM
|
Facility
OP
|
$1,991.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
3493524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$557.48 |
| Max. Negotiated Rate |
$1,831.72 |
| Rate for Payer: Aetna Commercial |
$1,791.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,712.26
|
| Rate for Payer: Aetna Managed Medicare |
$557.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,294.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$995.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$955.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,055.23
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,831.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,114.16
|
| Rate for Payer: Health EOS Commercial |
$1,771.99
|
| Rate for Payer: HFN Commercial |
$1,831.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,493.25
|
| Rate for Payer: Multiplan Commercial |
$1,592.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,194.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,831.72
|
| Rate for Payer: Quartz Beloit One Network |
$975.59
|
| Rate for Payer: Quartz Commercial |
$1,294.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,194.60
|
| Rate for Payer: WEA Trust Commercial |
$1,095.05
|
| Rate for Payer: WPS Commercial |
$1,474.73
|
|
|
CATHETER INFUSION 5FR 41058-01 135CM X 30CM
|
Facility
IP
|
$1,991.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
3493524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.59 |
| Max. Negotiated Rate |
$1,831.72 |
| Rate for Payer: Aetna Commercial |
$1,791.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,055.23
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,831.72
|
| Rate for Payer: Health EOS Commercial |
$1,771.99
|
| Rate for Payer: HFN Commercial |
$1,831.72
|
| Rate for Payer: Multiplan Commercial |
$1,592.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,194.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,831.72
|
| Rate for Payer: Quartz Beloit One Network |
$975.59
|
| Rate for Payer: Quartz Commercial |
$1,194.60
|
| Rate for Payer: WEA Trust Commercial |
$1,095.05
|
| Rate for Payer: WPS Commercial |
$1,474.73
|
|
|
CATHETER INSERTION, BROVIAC
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959909
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CATHETER INSERTION, BROVIAC
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959909
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CATHETER INSERTION, DIALYSIS
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CATHETER INSERTION, DIALYSIS
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CATHETER INSERTION, HICKMAN
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959911
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CATHETER INSERTION, HICKMAN
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959911
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
