|
CATHETER 22FR 30CC 3WAY FOLEY
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.21 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$79.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.16
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$169.73
|
| Rate for Payer: The Alliance Commercial |
$115.27
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
CATHETER 24FR 30CC 3WAY FOLEY
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.21 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$79.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.16
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$169.73
|
| Rate for Payer: The Alliance Commercial |
$115.27
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
CATHETER 24FR 30CC 3WAY FOLEY
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
CATHETER 24FR FOLEY 30CC 3 WAY IRRIG 0167L24
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
CATHETER 24FR FOLEY 30CC 3 WAY IRRIG 0167L24
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.38
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$169.10
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$169.10
|
| Rate for Payer: The Alliance Commercial |
$115.27
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
CATHETER 24FR THORACIC 14024
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
4081914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
CATHETER 24FR THORACIC 14024
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
4081914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$80.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.06
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$172.85
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$172.85
|
| Rate for Payer: The Alliance Commercial |
$144.04
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
CATHETER 24FR TIEMANN COUDE 010124
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2963537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
CATHETER 24FR TIEMANN COUDE 010124
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2963537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
CATHETER 2.5 x 20 #38959-2025
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.62
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$1,189.76
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
CATHETER 2.5 x 20 #38959-2025
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
CATHETER 3.0 x 15 #38959-1530
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2972947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
CATHETER 3.0 x 15 #38959-1530
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2972947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.62
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
CATHETER 32 FR STRAIGHT 8032
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2964015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
CATHETER 32 FR STRAIGHT 8032
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2964015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
CATHETER 36 FR STRAIGHT 8036
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2964016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.33
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.28
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$78.62
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| Rate for Payer: Quartz Medicare Advantage |
$78.62
|
| Rate for Payer: The Alliance Commercial |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
CATHETER 36 FR STRAIGHT 8036
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2964016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
CATHETER 5cm MICROMEWI
|
Facility
|
OP
|
$3,408.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2973139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$992.41 |
| Max. Negotiated Rate |
$3,260.77 |
| Rate for Payer: Aetna Commercial |
$3,189.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,048.12
|
| Rate for Payer: Aetna Managed Medicare |
$992.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,303.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,772.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,701.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,878.49
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$3,260.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,983.46
|
| Rate for Payer: Health EOS Commercial |
$3,154.44
|
| Rate for Payer: HFN Commercial |
$3,260.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,658.24
|
| Rate for Payer: Multiplan Commercial |
$2,835.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,126.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,260.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.72
|
| Rate for Payer: Quartz Commercial |
$2,303.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,126.59
|
| Rate for Payer: The Alliance Commercial |
$1,772.16
|
| Rate for Payer: WEA Trust Commercial |
$1,949.38
|
| Rate for Payer: WPS Commercial |
$2,625.18
|
|
|
CATHETER 5cm MICROMEWI
|
Facility
|
IP
|
$3,408.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2973139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,736.72 |
| Max. Negotiated Rate |
$3,260.77 |
| Rate for Payer: Aetna Commercial |
$3,189.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,048.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,878.49
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$3,260.77
|
| Rate for Payer: Health EOS Commercial |
$3,154.44
|
| Rate for Payer: HFN Commercial |
$3,260.77
|
| Rate for Payer: Multiplan Commercial |
$2,835.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,260.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.72
|
| Rate for Payer: Quartz Commercial |
$2,126.59
|
| Rate for Payer: WEA Trust Commercial |
$1,949.38
|
| Rate for Payer: WPS Commercial |
$2,625.18
|
|
|
CATHETER 5 FR. 1M 534-560T
|
Facility
|
IP
|
$410.00
|
|
| Hospital Charge Code |
2971312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$255.84
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
CATHETER 5 FR. 1M 534-560T
|
Facility
|
OP
|
$410.00
|
|
| Hospital Charge Code |
2971312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$119.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.62
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.80
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$255.84
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$277.16
|
| Rate for Payer: Quartz Medicare Advantage |
$255.84
|
| Rate for Payer: The Alliance Commercial |
$213.20
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
CATHETER 5FR. CRD 10MM SPACING 401433
|
Facility
|
OP
|
$4,149.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
2973488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,208.19 |
| Max. Negotiated Rate |
$3,969.76 |
| Rate for Payer: Aetna Commercial |
$3,883.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,710.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,208.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,804.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,157.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,071.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,286.93
|
| Rate for Payer: Cash Price |
$1,244.70
|
| Rate for Payer: Cigna Commercial |
$3,969.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,414.72
|
| Rate for Payer: Health EOS Commercial |
$3,840.31
|
| Rate for Payer: HFN Commercial |
$3,969.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,236.22
|
| Rate for Payer: Multiplan Commercial |
$3,451.97
|
| Rate for Payer: NAPHCARE Commercial |
$2,588.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,969.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,114.33
|
| Rate for Payer: Quartz Commercial |
$2,804.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,588.98
|
| Rate for Payer: The Alliance Commercial |
$2,157.48
|
| Rate for Payer: WEA Trust Commercial |
$2,373.23
|
| Rate for Payer: WPS Commercial |
$3,195.97
|
|
|
CATHETER 5FR. CRD 10MM SPACING 401433
|
Facility
|
IP
|
$4,149.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
2973488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,114.33 |
| Max. Negotiated Rate |
$3,969.76 |
| Rate for Payer: Aetna Commercial |
$3,883.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,710.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,286.93
|
| Rate for Payer: Cash Price |
$1,244.70
|
| Rate for Payer: Cigna Commercial |
$3,969.76
|
| Rate for Payer: Health EOS Commercial |
$3,840.31
|
| Rate for Payer: HFN Commercial |
$3,969.76
|
| Rate for Payer: Multiplan Commercial |
$3,451.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,969.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,114.33
|
| Rate for Payer: Quartz Commercial |
$2,588.98
|
| Rate for Payer: WEA Trust Commercial |
$2,373.23
|
| Rate for Payer: WPS Commercial |
$3,195.97
|
|
|
CATHETER 5FR EMBOLECTOMY AP4558
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.90 |
| Max. Negotiated Rate |
$1,152.94 |
| Rate for Payer: Aetna Commercial |
$1,127.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,077.75
|
| Rate for Payer: Aetna Managed Medicare |
$350.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$814.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$626.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$601.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.20
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,152.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$701.31
|
| Rate for Payer: Health EOS Commercial |
$1,115.35
|
| Rate for Payer: HFN Commercial |
$1,152.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.90
|
| Rate for Payer: Multiplan Commercial |
$1,002.56
|
| Rate for Payer: NAPHCARE Commercial |
$751.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,152.94
|
| Rate for Payer: Quartz Beloit One Network |
$614.07
|
| Rate for Payer: Quartz Commercial |
$814.58
|
| Rate for Payer: Quartz Medicare Advantage |
$751.92
|
| Rate for Payer: The Alliance Commercial |
$626.60
|
| Rate for Payer: WEA Trust Commercial |
$689.26
|
| Rate for Payer: WPS Commercial |
$928.21
|
|
|
CATHETER 5FR EMBOLECTOMY AP4558
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.07 |
| Max. Negotiated Rate |
$1,152.94 |
| Rate for Payer: Aetna Commercial |
$1,127.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,077.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.20
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,152.94
|
| Rate for Payer: Health EOS Commercial |
$1,115.35
|
| Rate for Payer: HFN Commercial |
$1,152.94
|
| Rate for Payer: Multiplan Commercial |
$1,002.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,152.94
|
| Rate for Payer: Quartz Beloit One Network |
$614.07
|
| Rate for Payer: Quartz Commercial |
$751.92
|
| Rate for Payer: WEA Trust Commercial |
$689.26
|
| Rate for Payer: WPS Commercial |
$928.21
|
|
