|
CATHETERIZATION KIT ARTERIAL NS-04100-S
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
2969902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
|
OP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,144.28 |
| Max. Negotiated Rate |
$59,204.00 |
| Rate for Payer: Aetna Commercial |
$13,320.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,728.86
|
| Rate for Payer: Aetna Managed Medicare |
$4,144.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,620.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,400.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,844.53
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$13,616.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,282.64
|
| Rate for Payer: Health EOS Commercial |
$13,172.89
|
| Rate for Payer: HFN Commercial |
$13,616.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,100.75
|
| Rate for Payer: Multiplan Commercial |
$11,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,616.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,252.49
|
| Rate for Payer: Quartz Commercial |
$9,620.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8,880.60
|
| Rate for Payer: The Alliance Commercial |
$59,204.00
|
| Rate for Payer: WEA Trust Commercial |
$8,140.55
|
| Rate for Payer: WPS Commercial |
$10,963.10
|
|
|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
|
IP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,252.49 |
| Max. Negotiated Rate |
$13,616.92 |
| Rate for Payer: Aetna Commercial |
$13,320.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,728.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,844.53
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$13,616.92
|
| Rate for Payer: Health EOS Commercial |
$13,172.89
|
| Rate for Payer: HFN Commercial |
$13,616.92
|
| Rate for Payer: Multiplan Commercial |
$11,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,616.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,252.49
|
| Rate for Payer: Quartz Commercial |
$8,880.60
|
| Rate for Payer: WEA Trust Commercial |
$8,140.55
|
| Rate for Payer: WPS Commercial |
$10,963.10
|
|
|
CATHETER JETSTREAM G3SF 1.6
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,808.60 |
| Max. Negotiated Rate |
$82,980.00 |
| Rate for Payer: Aetna Commercial |
$18,670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,840.70
|
| Rate for Payer: Aetna Managed Medicare |
$5,808.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,484.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,372.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,957.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,994.85
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,085.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,608.90
|
| Rate for Payer: Health EOS Commercial |
$18,463.05
|
| Rate for Payer: HFN Commercial |
$19,085.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,558.75
|
| Rate for Payer: Multiplan Commercial |
$16,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,085.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,165.05
|
| Rate for Payer: Quartz Commercial |
$13,484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12,447.00
|
| Rate for Payer: The Alliance Commercial |
$82,980.00
|
| Rate for Payer: WEA Trust Commercial |
$11,409.75
|
| Rate for Payer: WPS Commercial |
$15,365.82
|
|
|
CATHETER JETSTREAM G3SF 1.6
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,165.05 |
| Max. Negotiated Rate |
$19,085.40 |
| Rate for Payer: Aetna Commercial |
$18,670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,840.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,994.85
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,085.40
|
| Rate for Payer: Health EOS Commercial |
$18,463.05
|
| Rate for Payer: HFN Commercial |
$19,085.40
|
| Rate for Payer: Multiplan Commercial |
$16,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,085.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,165.05
|
| Rate for Payer: Quartz Commercial |
$12,447.00
|
| Rate for Payer: WEA Trust Commercial |
$11,409.75
|
| Rate for Payer: WPS Commercial |
$15,365.82
|
|
|
CATHETER JETSTREAM G3SF 1.85
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,808.60 |
| Max. Negotiated Rate |
$82,980.00 |
| Rate for Payer: Aetna Commercial |
$18,670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,840.70
|
| Rate for Payer: Aetna Managed Medicare |
$5,808.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,484.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,372.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,957.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,994.85
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,085.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,608.90
|
| Rate for Payer: Health EOS Commercial |
$18,463.05
|
| Rate for Payer: HFN Commercial |
$19,085.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,558.75
|
| Rate for Payer: Multiplan Commercial |
$16,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,085.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,165.05
|
| Rate for Payer: Quartz Commercial |
$13,484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12,447.00
|
| Rate for Payer: The Alliance Commercial |
$82,980.00
|
| Rate for Payer: WEA Trust Commercial |
$11,409.75
|
| Rate for Payer: WPS Commercial |
$15,365.82
|
|
|
CATHETER JETSTREAM G3SF 1.85
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,165.05 |
| Max. Negotiated Rate |
$19,085.40 |
| Rate for Payer: Aetna Commercial |
$18,670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,840.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,994.85
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,085.40
|
| Rate for Payer: Health EOS Commercial |
$18,463.05
|
| Rate for Payer: HFN Commercial |
$19,085.40
|
| Rate for Payer: Multiplan Commercial |
$16,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,085.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,165.05
|
| Rate for Payer: Quartz Commercial |
$12,447.00
|
| Rate for Payer: WEA Trust Commercial |
$11,409.75
|
| Rate for Payer: WPS Commercial |
$15,365.82
|
|
|
CATHETER JETSTREAM L
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,165.05 |
| Max. Negotiated Rate |
$19,085.40 |
| Rate for Payer: Aetna Commercial |
$18,670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,840.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,994.85
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,085.40
|
| Rate for Payer: Health EOS Commercial |
$18,463.05
|
| Rate for Payer: HFN Commercial |
$19,085.40
|
| Rate for Payer: Multiplan Commercial |
$16,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,085.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,165.05
|
| Rate for Payer: Quartz Commercial |
$12,447.00
|
| Rate for Payer: WEA Trust Commercial |
$11,409.75
|
| Rate for Payer: WPS Commercial |
$15,365.82
|
|
|
CATHETER JETSTREAM L
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,808.60 |
| Max. Negotiated Rate |
$82,980.00 |
| Rate for Payer: Aetna Commercial |
$18,670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,840.70
|
| Rate for Payer: Aetna Managed Medicare |
$5,808.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,484.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,372.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,957.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,994.85
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,085.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,608.90
|
| Rate for Payer: Health EOS Commercial |
$18,463.05
|
| Rate for Payer: HFN Commercial |
$19,085.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,558.75
|
| Rate for Payer: Multiplan Commercial |
$16,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,085.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,165.05
|
| Rate for Payer: Quartz Commercial |
$13,484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12,447.00
|
| Rate for Payer: The Alliance Commercial |
$82,980.00
|
| Rate for Payer: WEA Trust Commercial |
$11,409.75
|
| Rate for Payer: WPS Commercial |
$15,365.82
|
|
|
CATHETER JL4 T 6FR 534620T
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2971393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER JL4 T 6FR 534620T
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2971393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
CATHETER KIT FEMALE 8FR 0035720
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2963307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
CATHETER KIT FEMALE 8FR 0035720
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2963307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
CATHETER KUMAR CHOLANGIOGRAPHY CC-019
|
Facility
|
OP
|
$679.00
|
|
| Hospital Charge Code |
5178933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: Aetna Commercial |
$611.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.94
|
| Rate for Payer: Aetna Managed Medicare |
$190.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$441.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.87
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$624.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.97
|
| Rate for Payer: Health EOS Commercial |
$604.31
|
| Rate for Payer: HFN Commercial |
$624.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$509.25
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: NAPHCARE Commercial |
$407.40
|
| Rate for Payer: Preferred Network Access Commercial |
$624.68
|
| Rate for Payer: Quartz Beloit One Network |
$332.71
|
| Rate for Payer: Quartz Commercial |
$441.35
|
| Rate for Payer: Quartz Medicare Advantage |
$407.40
|
| Rate for Payer: The Alliance Commercial |
$2,716.00
|
| Rate for Payer: WEA Trust Commercial |
$373.45
|
| Rate for Payer: WPS Commercial |
$502.94
|
|
|
CATHETER KUMAR CHOLANGIOGRAPHY CC-019
|
Facility
|
IP
|
$679.00
|
|
| Hospital Charge Code |
5178933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.71 |
| Max. Negotiated Rate |
$624.68 |
| Rate for Payer: Aetna Commercial |
$611.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.87
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$624.68
|
| Rate for Payer: Health EOS Commercial |
$604.31
|
| Rate for Payer: HFN Commercial |
$624.68
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: NAPHCARE Commercial |
$407.40
|
| Rate for Payer: Preferred Network Access Commercial |
$624.68
|
| Rate for Payer: Quartz Beloit One Network |
$332.71
|
| Rate for Payer: Quartz Commercial |
$407.40
|
| Rate for Payer: WEA Trust Commercial |
$373.45
|
| Rate for Payer: WPS Commercial |
$502.94
|
|
|
CATHETER LATEX 24fr 0165L24
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
2974584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$28.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$61.20
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
CATHETER LATEX 24fr 0165L24
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
2974584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
CATHETER LEFT HEART VENT 16FR PEAK LVV-016S
|
Facility
|
IP
|
$364.00
|
|
| Hospital Charge Code |
5831769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
CATHETER LEFT HEART VENT 16FR PEAK LVV-016S
|
Facility
|
OP
|
$364.00
|
|
| Hospital Charge Code |
5831769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$1,456.00 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.69
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$1,456.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
CATHETER LEFT HEART VENT 18FR PEAK LVV-018S
|
Facility
|
OP
|
$379.00
|
|
| Hospital Charge Code |
5831768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.12 |
| Max. Negotiated Rate |
$1,516.00 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Aetna Managed Medicare |
$106.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.09
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$284.25
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$227.40
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$246.35
|
| Rate for Payer: Quartz Medicare Advantage |
$227.40
|
| Rate for Payer: The Alliance Commercial |
$1,516.00
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
CATHETER LEFT HEART VENT 18FR PEAK LVV-018S
|
Facility
|
IP
|
$379.00
|
|
| Hospital Charge Code |
5831768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$227.40
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$227.40
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
CATHETER LEFT HEART VENT DLP 18FR (6.0MM) MALLEABLE NON-VENTED 12118
|
Facility
|
IP
|
$470.00
|
|
| Hospital Charge Code |
4858648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.30 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.10
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$432.40
|
| Rate for Payer: Health EOS Commercial |
$418.30
|
| Rate for Payer: HFN Commercial |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: NAPHCARE Commercial |
$282.00
|
| Rate for Payer: Preferred Network Access Commercial |
$432.40
|
| Rate for Payer: Quartz Beloit One Network |
$230.30
|
| Rate for Payer: Quartz Commercial |
$282.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
CATHETER LEFT HEART VENT DLP 18FR (6.0MM) MALLEABLE NON-VENTED 12118
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
4858648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$1,880.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Aetna Managed Medicare |
$131.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$305.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.10
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$432.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.01
|
| Rate for Payer: Health EOS Commercial |
$418.30
|
| Rate for Payer: HFN Commercial |
$432.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$352.50
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: NAPHCARE Commercial |
$282.00
|
| Rate for Payer: Preferred Network Access Commercial |
$432.40
|
| Rate for Payer: Quartz Beloit One Network |
$230.30
|
| Rate for Payer: Quartz Commercial |
$305.50
|
| Rate for Payer: Quartz Medicare Advantage |
$282.00
|
| Rate for Payer: The Alliance Commercial |
$1,880.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
CATHETER MAC-LOC MULTIPURPOSE DRAINAGE 10.2FR X 45CM ULTRATHANE G09766
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.83 |
| Max. Negotiated Rate |
$1,349.64 |
| Rate for Payer: Aetna Commercial |
$1,320.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.51
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,349.64
|
| Rate for Payer: Health EOS Commercial |
$1,305.63
|
| Rate for Payer: HFN Commercial |
$1,349.64
|
| Rate for Payer: Multiplan Commercial |
$1,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$880.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.64
|
| Rate for Payer: Quartz Beloit One Network |
$718.83
|
| Rate for Payer: Quartz Commercial |
$880.20
|
| Rate for Payer: WEA Trust Commercial |
$806.85
|
| Rate for Payer: WPS Commercial |
$1,086.61
|
|
|
CATHETER MAC-LOC MULTIPURPOSE DRAINAGE 10.2FR X 45CM ULTRATHANE G09766
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.76 |
| Max. Negotiated Rate |
$5,868.00 |
| Rate for Payer: Aetna Commercial |
$1,320.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.62
|
| Rate for Payer: Aetna Managed Medicare |
$410.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$953.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$704.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.51
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,349.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.93
|
| Rate for Payer: Health EOS Commercial |
$1,305.63
|
| Rate for Payer: HFN Commercial |
$1,349.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,100.25
|
| Rate for Payer: Multiplan Commercial |
$1,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$880.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.64
|
| Rate for Payer: Quartz Beloit One Network |
$718.83
|
| Rate for Payer: Quartz Commercial |
$953.55
|
| Rate for Payer: Quartz Medicare Advantage |
$880.20
|
| Rate for Payer: The Alliance Commercial |
$5,868.00
|
| Rate for Payer: WEA Trust Commercial |
$806.85
|
| Rate for Payer: WPS Commercial |
$1,086.61
|
|
