|
CATHETER APEX 3.5 x 20
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 3.5 x 20
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 3.5 x 30
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 3.5 x 30
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 3.5 x 8
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 3.5 x 8
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 4.0 x 15
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 4.0 x 15
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 4.0 x 20
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 4.0 x 20
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 4.0 x 8
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER APEX 4.0 x 8
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
CATHETER AR1 SH GUIDE 8FR. 588-836
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$822.22 |
| Max. Negotiated Rate |
$1,543.76 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,006.80
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
CATHETER AR1 SH GUIDE 8FR. 588-836
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$6,712.00 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Aetna Managed Medicare |
$469.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.01
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,090.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.80
|
| Rate for Payer: The Alliance Commercial |
$6,712.00
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
CATHETER AR2 SH GUIDE 8FR 588837
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| 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: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
CATHETER AR2 SH GUIDE 8FR 588837
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971742
|
|
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
|
|
|
CATHETER ARROW-KARLAN LAP CHOLANGIOGRAPHY BALLOON CS-01700
|
Facility
|
IP
|
$1,305.00
|
|
| Hospital Charge Code |
2962935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.45 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Aetna Commercial |
$1,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.65
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,200.60
|
| Rate for Payer: Health EOS Commercial |
$1,161.45
|
| Rate for Payer: HFN Commercial |
$1,200.60
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: NAPHCARE Commercial |
$783.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.60
|
| Rate for Payer: Quartz Beloit One Network |
$639.45
|
| Rate for Payer: Quartz Commercial |
$783.00
|
| Rate for Payer: WEA Trust Commercial |
$717.75
|
| Rate for Payer: WPS Commercial |
$966.61
|
|
|
CATHETER ARROW-KARLAN LAP CHOLANGIOGRAPHY BALLOON CS-01700
|
Facility
|
OP
|
$1,305.00
|
|
| Hospital Charge Code |
2962935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$5,220.00 |
| Rate for Payer: Aetna Commercial |
$1,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.30
|
| Rate for Payer: Aetna Managed Medicare |
$365.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.65
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,200.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.28
|
| Rate for Payer: Health EOS Commercial |
$1,161.45
|
| Rate for Payer: HFN Commercial |
$1,200.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.75
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: NAPHCARE Commercial |
$783.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.60
|
| Rate for Payer: Quartz Beloit One Network |
$639.45
|
| Rate for Payer: Quartz Commercial |
$848.25
|
| Rate for Payer: Quartz Medicare Advantage |
$783.00
|
| Rate for Payer: The Alliance Commercial |
$5,220.00
|
| Rate for Payer: WEA Trust Commercial |
$717.75
|
| Rate for Payer: WPS Commercial |
$966.61
|
|
|
CATHETER ASPIRATION 2.3mm 240cm 2181
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
4508662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CATHETER ASPIRATION 2.3mm 240cm 2181
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
4508662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CATHETER ATTAIN
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN STRAIGHT
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN STRAIGHT
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
CATHETER ATTAIN VENOGRAM 6215 KIT
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: 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
|
|
