|
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 |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
CATHETER ARROW-KARLAN LAP CHOLANGIOGRAPHY BALLOON CS-01700
|
Facility
|
IP
|
$1,305.00
|
|
| Hospital Charge Code |
2962935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.03 |
| Max. Negotiated Rate |
$1,248.62 |
| Rate for Payer: Aetna Commercial |
$1,221.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.32
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,248.62
|
| Rate for Payer: Health EOS Commercial |
$1,207.91
|
| Rate for Payer: HFN Commercial |
$1,248.62
|
| Rate for Payer: Multiplan Commercial |
$1,085.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.62
|
| Rate for Payer: Quartz Beloit One Network |
$665.03
|
| Rate for Payer: Quartz Commercial |
$814.32
|
| Rate for Payer: WEA Trust Commercial |
$746.46
|
| Rate for Payer: WPS Commercial |
$1,005.24
|
|
|
CATHETER ARROW-KARLAN LAP CHOLANGIOGRAPHY BALLOON CS-01700
|
Facility
|
OP
|
$1,305.00
|
|
| Hospital Charge Code |
2962935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.02 |
| Max. Negotiated Rate |
$1,248.62 |
| Rate for Payer: Aetna Commercial |
$1,221.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.19
|
| Rate for Payer: Aetna Managed Medicare |
$380.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$678.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.32
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,248.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.51
|
| Rate for Payer: Health EOS Commercial |
$1,207.91
|
| Rate for Payer: HFN Commercial |
$1,248.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,017.90
|
| Rate for Payer: Multiplan Commercial |
$1,085.76
|
| Rate for Payer: NAPHCARE Commercial |
$814.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.62
|
| Rate for Payer: Quartz Beloit One Network |
$665.03
|
| Rate for Payer: Quartz Commercial |
$882.18
|
| Rate for Payer: Quartz Medicare Advantage |
$814.32
|
| Rate for Payer: The Alliance Commercial |
$678.60
|
| Rate for Payer: WEA Trust Commercial |
$746.46
|
| Rate for Payer: WPS Commercial |
$1,005.24
|
|
|
CATHETER ASPIRATION 2.3mm 240cm 2181
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
4508662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
CATHETER ASPIRATION 2.3mm 240cm 2181
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
4508662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
CATHETER ATTAIN
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
CATHETER ATTAIN
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
CATHETER ATTAIN STRAIGHT
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
CATHETER ATTAIN STRAIGHT
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
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 |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
CATHETER ATTAIN VENOGRAM 6215 KIT
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
CATHETER BERN IMAGER II 5FR X 40CM M0064005030
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER BERN IMAGER II 5FR X 40CM M0064005030
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER BERN IMAGER II 5FR X 65CM M0064003030
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER BERN IMAGER II 5FR X 65CM M0064003030
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER CABLE
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972961
|
|
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 CABLE
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972961
|
|
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 CAP #418027
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
2970155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
CATHETER CAP #418027
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
2970155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
CATHETER CLOSUREFAST 3CM CF7-3-60
|
Facility
|
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,271.36 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,271.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,272.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,893.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,539.60
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,084.00
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,867.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$5,272.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,867.20
|
| Rate for Payer: The Alliance Commercial |
$4,056.00
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 3CM CF7-3-60
|
Facility
|
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,974.88 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$4,867.20
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 7FR 100CM CF7-7-100
|
Facility
|
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,271.36 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,271.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,272.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,893.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,539.60
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,084.00
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,867.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$5,272.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,867.20
|
| Rate for Payer: The Alliance Commercial |
$4,056.00
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 7FR 100CM CF7-7-100
|
Facility
|
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,974.88 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$4,867.20
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 7FR 60CM CF7-7-60
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,359.01 |
| Max. Negotiated Rate |
$7,751.04 |
| Rate for Payer: Aetna Commercial |
$7,582.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,245.53
|
| Rate for Payer: Aetna Managed Medicare |
$2,359.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,476.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,212.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,044.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,465.27
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,751.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,714.78
|
| Rate for Payer: Health EOS Commercial |
$7,498.29
|
| Rate for Payer: HFN Commercial |
$7,751.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,318.78
|
| Rate for Payer: Multiplan Commercial |
$6,740.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,055.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,751.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.27
|
| Rate for Payer: Quartz Commercial |
$5,476.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,055.02
|
| Rate for Payer: The Alliance Commercial |
$4,212.52
|
| Rate for Payer: WEA Trust Commercial |
$4,633.77
|
| Rate for Payer: WPS Commercial |
$6,240.20
|
|
|
CATHETER CLOSUREFAST 7FR 60CM CF7-7-60
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,128.27 |
| Max. Negotiated Rate |
$7,751.04 |
| Rate for Payer: Aetna Commercial |
$7,582.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,245.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,465.27
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,751.04
|
| Rate for Payer: Health EOS Commercial |
$7,498.29
|
| Rate for Payer: HFN Commercial |
$7,751.04
|
| Rate for Payer: Multiplan Commercial |
$6,740.03
|
| Rate for Payer: Preferred Network Access Commercial |
$7,751.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.27
|
| Rate for Payer: Quartz Commercial |
$5,055.02
|
| Rate for Payer: WEA Trust Commercial |
$4,633.77
|
| Rate for Payer: WPS Commercial |
$6,240.20
|
|
