|
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
|
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 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 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 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 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. 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 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
|
|
|
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 5 FR. MPA 2 #534-542T
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972765
|
|
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. MPA 2 #534-542T
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972765
|
|
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 6FR.145 DEG. ANG. 534652S
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2972767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER 6FR.145 DEG. ANG. 534652S
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2972767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER 6FR. ALII 534-646T
|
Facility
|
IP
|
$497.00
|
|
| Hospital Charge Code |
2972693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
CATHETER 6FR. ALII 534-646T
|
Facility
|
OP
|
$497.00
|
|
| Hospital Charge Code |
2972693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.73 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$258.44
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
CATHETER 6fr. ALIII ST 532-647
|
Facility
|
OP
|
$482.00
|
|
| Hospital Charge Code |
2971202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.36 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Aetna Managed Medicare |
$140.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.52
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.96
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: NAPHCARE Commercial |
$300.77
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$325.83
|
| Rate for Payer: Quartz Medicare Advantage |
$300.77
|
| Rate for Payer: The Alliance Commercial |
$250.64
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
CATHETER 6fr. ALIII ST 532-647
|
Facility
|
IP
|
$482.00
|
|
| Hospital Charge Code |
2971202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$300.77
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
CATHETER 6 FR. ALI ST. 532645
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER 6 FR. ALI ST. 532645
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER 6FR. AR MOD 534648T
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
