|
CATHETER ABLATION ORANGE #D7TFL252RT
|
Facility
|
OP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,301.92 |
| Max. Negotiated Rate |
$10,849.16 |
| Rate for Payer: Aetna Commercial |
$10,613.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,141.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,301.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,665.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,896.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,660.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,250.06
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,849.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,599.30
|
| Rate for Payer: Health EOS Commercial |
$10,495.38
|
| Rate for Payer: HFN Commercial |
$10,849.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,844.42
|
| Rate for Payer: Multiplan Commercial |
$9,434.05
|
| Rate for Payer: NAPHCARE Commercial |
$7,075.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,849.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,778.35
|
| Rate for Payer: Quartz Commercial |
$7,665.16
|
| Rate for Payer: Quartz Medicare Advantage |
$7,075.54
|
| Rate for Payer: The Alliance Commercial |
$5,896.28
|
| Rate for Payer: WEA Trust Commercial |
$6,485.91
|
| Rate for Payer: WPS Commercial |
$8,734.43
|
|
|
Catheter Angio #14
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
3101772
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Catheter Angio #14
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
3101772
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$27.04
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Catheter,Angio #14
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Catheter,Angio #14
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
CATHETER ANGIO 20GX1.75 383538
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
4519146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$44.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
CATHETER ANGIO 20GX1.75 383538
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
4519146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
CATHETER ANGIOGRAPHIC 4 FR STRAIGHT 526-422
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2973211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$280.18
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIOGRAPHIC 4 FR STRAIGHT 526-422
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
2973211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.75 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$130.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$303.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.32
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.22
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$280.18
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$303.52
|
| Rate for Payer: Quartz Medicare Advantage |
$280.18
|
| Rate for Payer: The Alliance Commercial |
$233.48
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIOGRAPHIC 5 FR STRAIGHT 526-522
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2972356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$280.18
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIOGRAPHIC 5 FR STRAIGHT 526-522
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
2972356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.75 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$130.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$303.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.32
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.22
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$280.18
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$303.52
|
| Rate for Payer: Quartz Medicare Advantage |
$280.18
|
| Rate for Payer: The Alliance Commercial |
$233.48
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIO SAFETY 18X1 3/4
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2962943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
CATHETER ANGIO SAFETY 18X1 3/4
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2962943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
CATHETER ANGIO SAFETY 24X3/4
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2968886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
CATHETER ANGIO SAFETY 24X3/4
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2968886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$44.72
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
CATHETER APEX 1.5 x 15
|
Facility
|
OP
|
$2,081.00
|
|
| Hospital Charge Code |
2971019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.99 |
| Max. Negotiated Rate |
$1,991.10 |
| Rate for Payer: Aetna Commercial |
$1,947.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.25
|
| Rate for Payer: Aetna Managed Medicare |
$605.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,406.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,082.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,038.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.05
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cigna Commercial |
$1,991.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,211.14
|
| Rate for Payer: Health EOS Commercial |
$1,926.17
|
| Rate for Payer: HFN Commercial |
$1,991.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,623.18
|
| Rate for Payer: Multiplan Commercial |
$1,731.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,298.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.48
|
| Rate for Payer: Quartz Commercial |
$1,406.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,298.54
|
| Rate for Payer: The Alliance Commercial |
$1,082.12
|
| Rate for Payer: WEA Trust Commercial |
$1,190.33
|
| Rate for Payer: WPS Commercial |
$1,602.99
|
|
|
CATHETER APEX 1.5 x 15
|
Facility
|
IP
|
$2,081.00
|
|
| Hospital Charge Code |
2971019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.48 |
| Max. Negotiated Rate |
$1,991.10 |
| Rate for Payer: Aetna Commercial |
$1,947.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.05
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cigna Commercial |
$1,991.10
|
| Rate for Payer: Health EOS Commercial |
$1,926.17
|
| Rate for Payer: HFN Commercial |
$1,991.10
|
| Rate for Payer: Multiplan Commercial |
$1,731.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.48
|
| Rate for Payer: Quartz Commercial |
$1,298.54
|
| Rate for Payer: WEA Trust Commercial |
$1,190.33
|
| Rate for Payer: WPS Commercial |
$1,602.99
|
|
|
CATHETER APEX 2.0 x 15
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972945
|
|
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 APEX 2.0 x 15
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972945
|
|
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 APEX 2.0 X 20
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972950
|
|
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 APEX 2.0 X 20
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972950
|
|
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 APEX 2.0 x 8
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972941
|
|
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 APEX 2.0 x 8
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972941
|
|
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 APEX 2.5 x 15
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972946
|
|
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 APEX 2.5 x 15
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972946
|
|
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
|
|
