|
CATHETER INSERTION, INDWELLING
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959913
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, INDWELLING
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959913
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, INFUSE A PORT
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960155
|
|
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, INFUSE A PORT
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960155
|
|
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, INTRAJUGULAR
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959912
|
|
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, INTRAJUGULAR
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959912
|
|
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, PERITONEAL DIALYSIS
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959914
|
|
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, PERITONEAL DIALYSIS
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959914
|
|
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, PERMA
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, PERMA
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, QUINTON
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959916
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, QUINTON
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959916
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, SUPRAPUBIC
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959917
|
|
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, SUPRAPUBIC
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959917
|
|
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, SWAN GANZ
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959918
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INSERTION, SWAN GANZ
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959918
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CATHETER INTRAUTERINE PRESSURE IPC-5000E
|
Facility
IP
|
$658.00
|
|
| Hospital Charge Code |
2962962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$394.80
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$394.80
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
CATHETER INTRAUTERINE PRESSURE IPC-5000E
|
Facility
OP
|
$658.00
|
|
| Hospital Charge Code |
2962962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$2,632.00 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Aetna Managed Medicare |
$184.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$427.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$315.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.22
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.50
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$394.80
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$427.70
|
| Rate for Payer: Quartz Medicare Advantage |
$394.80
|
| Rate for Payer: The Alliance Commercial |
$2,632.00
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
CATHETER IV RADIAL ARTERY 20GA RA-04020
|
Facility
OP
|
$223.00
|
|
| Hospital Charge Code |
2962925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
CATHETER IV RADIAL ARTERY 20GA RA-04020
|
Facility
IP
|
$223.00
|
|
| Hospital Charge Code |
2962925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
CATHETER IV RADIAL ARTERY SET
|
Facility
IP
|
$809.00
|
|
| Hospital Charge Code |
2974566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.41 |
| Max. Negotiated Rate |
$744.28 |
| Rate for Payer: Aetna Commercial |
$728.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.77
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$744.28
|
| Rate for Payer: Health EOS Commercial |
$720.01
|
| Rate for Payer: HFN Commercial |
$744.28
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: NAPHCARE Commercial |
$485.40
|
| Rate for Payer: Preferred Network Access Commercial |
$744.28
|
| Rate for Payer: Quartz Beloit One Network |
$396.41
|
| Rate for Payer: Quartz Commercial |
$485.40
|
| Rate for Payer: WEA Trust Commercial |
$444.95
|
| Rate for Payer: WPS Commercial |
$599.23
|
|
|
CATHETER IV RADIAL ARTERY SET
|
Facility
OP
|
$809.00
|
|
| Hospital Charge Code |
2974566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.52 |
| Max. Negotiated Rate |
$3,236.00 |
| Rate for Payer: Aetna Commercial |
$728.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.74
|
| Rate for Payer: Aetna Managed Medicare |
$226.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.77
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$744.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.72
|
| Rate for Payer: Health EOS Commercial |
$720.01
|
| Rate for Payer: HFN Commercial |
$744.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.75
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: NAPHCARE Commercial |
$485.40
|
| Rate for Payer: Preferred Network Access Commercial |
$744.28
|
| Rate for Payer: Quartz Beloit One Network |
$396.41
|
| Rate for Payer: Quartz Commercial |
$525.85
|
| Rate for Payer: Quartz Medicare Advantage |
$485.40
|
| Rate for Payer: The Alliance Commercial |
$3,236.00
|
| Rate for Payer: WEA Trust Commercial |
$444.95
|
| Rate for Payer: WPS Commercial |
$599.23
|
|
|
CATHETERIZATION KIT ARTERIAL NS-04100-S
|
Facility
IP
|
$630.00
|
|
| Hospital Charge Code |
2969902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
CATHETERIZATION KIT ARTERIAL NS-04100-S
|
Facility
OP
|
$630.00
|
|
| Hospital Charge Code |
2969902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Aetna Managed Medicare |
$176.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.55
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$409.50
|
| Rate for Payer: Quartz Medicare Advantage |
$378.00
|
| Rate for Payer: The Alliance Commercial |
$2,520.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
OP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,144.28 |
| Max. Negotiated Rate |
$13,616.92 |
| Rate for Payer: Aetna Commercial |
$13,320.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,728.86
|
| Rate for Payer: Aetna Managed Medicare |
$4,144.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,620.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,400.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,844.53
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$13,616.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,282.64
|
| Rate for Payer: Health EOS Commercial |
$13,172.89
|
| Rate for Payer: HFN Commercial |
$13,616.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,100.75
|
| Rate for Payer: Multiplan Commercial |
$11,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,616.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,252.49
|
| Rate for Payer: Quartz Commercial |
$9,620.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8,880.60
|
| Rate for Payer: WEA Trust Commercial |
$8,140.55
|
| Rate for Payer: WPS Commercial |
$10,963.10
|
|
