|
CATHETER CONE TIP 10FR URETERAL G14665
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP 10FR URETERAL G14665
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP12FR URETERAL 024607
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP12FR URETERAL 024607
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP 5FR URETERAL M0064002110
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 5FR URETERAL M0064002110
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 6FR X 70CM 10FR TIP URETERAL M0064002121
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4519310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 6FR X 70CM 10FR TIP URETERAL M0064002121
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4519310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 7FR X 70CM URETERAL M0064002130
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 7FR X 70CM URETERAL M0064002130
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 8FR URETERAL G14663
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2963868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$61.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$132.29
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
CATHETER CONE TIP 8FR URETERAL G14663
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2963868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
CATHETER CROSSER CTO
|
Facility
|
OP
|
$13,392.00
|
|
| Hospital Charge Code |
2973903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,899.75 |
| Max. Negotiated Rate |
$12,813.47 |
| Rate for Payer: Aetna Commercial |
$12,534.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,977.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,899.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,052.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,963.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,685.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,381.67
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Cigna Commercial |
$12,813.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,794.14
|
| Rate for Payer: Health EOS Commercial |
$12,395.64
|
| Rate for Payer: HFN Commercial |
$12,813.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,445.76
|
| Rate for Payer: Multiplan Commercial |
$11,142.14
|
| Rate for Payer: NAPHCARE Commercial |
$8,356.61
|
| Rate for Payer: Preferred Network Access Commercial |
$12,813.47
|
| Rate for Payer: Quartz Beloit One Network |
$6,824.56
|
| Rate for Payer: Quartz Commercial |
$9,052.99
|
| Rate for Payer: Quartz Medicare Advantage |
$8,356.61
|
| Rate for Payer: The Alliance Commercial |
$6,963.84
|
| Rate for Payer: WEA Trust Commercial |
$7,660.22
|
| Rate for Payer: WPS Commercial |
$10,315.86
|
|
|
CATHETER CROSSER CTO
|
Facility
|
IP
|
$13,392.00
|
|
| Hospital Charge Code |
2973903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,824.56 |
| Max. Negotiated Rate |
$12,813.47 |
| Rate for Payer: Aetna Commercial |
$12,534.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,977.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,381.67
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Cigna Commercial |
$12,813.47
|
| Rate for Payer: Health EOS Commercial |
$12,395.64
|
| Rate for Payer: HFN Commercial |
$12,813.47
|
| Rate for Payer: Multiplan Commercial |
$11,142.14
|
| Rate for Payer: Preferred Network Access Commercial |
$12,813.47
|
| Rate for Payer: Quartz Beloit One Network |
$6,824.56
|
| Rate for Payer: Quartz Commercial |
$8,356.61
|
| Rate for Payer: WEA Trust Commercial |
$7,660.22
|
| Rate for Payer: WPS Commercial |
$10,315.86
|
|
|
CATHETER CS & HRA 20 POLE
|
Facility
|
OP
|
$6,397.00
|
|
| Hospital Charge Code |
2973708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,862.81 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,862.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,324.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,326.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,193.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.03
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,120.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,723.05
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,989.66
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,991.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$4,324.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,991.73
|
| Rate for Payer: The Alliance Commercial |
$3,326.44
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
CATHETER CS & HRA 20 POLE
|
Facility
|
IP
|
$6,397.00
|
|
| Hospital Charge Code |
2973708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,259.91 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.03
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,120.65
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$3,991.73
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
CATHETER CURL 62cm 8817278006
|
Facility
|
IP
|
$1,863.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
2973652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.38 |
| Max. Negotiated Rate |
$1,782.52 |
| Rate for Payer: Aetna Commercial |
$1,743.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,666.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.89
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna Commercial |
$1,782.52
|
| Rate for Payer: Health EOS Commercial |
$1,724.39
|
| Rate for Payer: HFN Commercial |
$1,782.52
|
| Rate for Payer: Multiplan Commercial |
$1,550.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,782.52
|
| Rate for Payer: Quartz Beloit One Network |
$949.38
|
| Rate for Payer: Quartz Commercial |
$1,162.51
|
| Rate for Payer: WEA Trust Commercial |
$1,065.64
|
| Rate for Payer: WPS Commercial |
$1,435.07
|
|
|
CATHETER CURL 62cm 8817278006
|
Facility
|
OP
|
$1,863.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
2973652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.51 |
| Max. Negotiated Rate |
$1,782.52 |
| Rate for Payer: Aetna Commercial |
$1,743.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,666.27
|
| Rate for Payer: Aetna Managed Medicare |
$542.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,259.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$968.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.89
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna Commercial |
$1,782.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.27
|
| Rate for Payer: Health EOS Commercial |
$1,724.39
|
| Rate for Payer: HFN Commercial |
$1,782.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.14
|
| Rate for Payer: Multiplan Commercial |
$1,550.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,162.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,782.52
|
| Rate for Payer: Quartz Beloit One Network |
$949.38
|
| Rate for Payer: Quartz Commercial |
$1,259.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,162.51
|
| Rate for Payer: The Alliance Commercial |
$968.76
|
| Rate for Payer: WEA Trust Commercial |
$1,065.64
|
| Rate for Payer: WPS Commercial |
$1,435.07
|
|
|
CATHETER CURVE ABLATION LG.
|
Facility
|
OP
|
$6,316.00
|
|
| Hospital Charge Code |
2973761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,839.22 |
| Max. Negotiated Rate |
$6,043.15 |
| Rate for Payer: Aetna Commercial |
$5,911.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,649.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,839.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,269.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,284.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,152.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,481.38
|
| Rate for Payer: Cash Price |
$1,894.80
|
| Rate for Payer: Cigna Commercial |
$6,043.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,675.91
|
| Rate for Payer: Health EOS Commercial |
$5,846.09
|
| Rate for Payer: HFN Commercial |
$6,043.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,926.48
|
| Rate for Payer: Multiplan Commercial |
$5,254.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,941.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,043.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,218.63
|
| Rate for Payer: Quartz Commercial |
$4,269.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,941.18
|
| Rate for Payer: The Alliance Commercial |
$3,284.32
|
| Rate for Payer: WEA Trust Commercial |
$3,612.75
|
| Rate for Payer: WPS Commercial |
$4,865.21
|
|
|
CATHETER CURVE ABLATION LG.
|
Facility
|
IP
|
$6,316.00
|
|
| Hospital Charge Code |
2973761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,218.63 |
| Max. Negotiated Rate |
$6,043.15 |
| Rate for Payer: Aetna Commercial |
$5,911.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,649.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,481.38
|
| Rate for Payer: Cash Price |
$1,894.80
|
| Rate for Payer: Cigna Commercial |
$6,043.15
|
| Rate for Payer: Health EOS Commercial |
$5,846.09
|
| Rate for Payer: HFN Commercial |
$6,043.15
|
| Rate for Payer: Multiplan Commercial |
$5,254.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,043.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,218.63
|
| Rate for Payer: Quartz Commercial |
$3,941.18
|
| Rate for Payer: WEA Trust Commercial |
$3,612.75
|
| Rate for Payer: WPS Commercial |
$4,865.21
|
|
|
CATHETER DBD PACING SWAN GANZ W/O HEPARIN
|
Facility
|
IP
|
$4,413.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962945
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,248.86 |
| Max. Negotiated Rate |
$4,222.36 |
| Rate for Payer: Aetna Commercial |
$4,130.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,946.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,432.45
|
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Cigna Commercial |
$4,222.36
|
| Rate for Payer: Health EOS Commercial |
$4,084.67
|
| Rate for Payer: HFN Commercial |
$4,222.36
|
| Rate for Payer: Multiplan Commercial |
$3,671.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,222.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,248.86
|
| Rate for Payer: Quartz Commercial |
$2,753.71
|
| Rate for Payer: WEA Trust Commercial |
$2,524.24
|
| Rate for Payer: WPS Commercial |
$3,399.33
|
|
|
CATHETER DBD PACING SWAN GANZ W/O HEPARIN
|
Facility
|
OP
|
$4,413.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962945
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,285.07 |
| Max. Negotiated Rate |
$4,222.36 |
| Rate for Payer: Aetna Commercial |
$4,130.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,946.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,285.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,983.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,294.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,202.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,432.45
|
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Cigna Commercial |
$4,222.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,568.37
|
| Rate for Payer: Health EOS Commercial |
$4,084.67
|
| Rate for Payer: HFN Commercial |
$4,222.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,442.14
|
| Rate for Payer: Multiplan Commercial |
$3,671.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,753.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,222.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,248.86
|
| Rate for Payer: Quartz Commercial |
$2,983.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,753.71
|
| Rate for Payer: The Alliance Commercial |
$2,294.76
|
| Rate for Payer: WEA Trust Commercial |
$2,524.24
|
| Rate for Payer: WPS Commercial |
$3,399.33
|
|
|
CATHETER DRAINAGE 12fr ANGIOTE #756512025
|
Facility
|
IP
|
$1,666.00
|
|
| Hospital Charge Code |
2973596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$848.99 |
| Max. Negotiated Rate |
$1,594.03 |
| Rate for Payer: Aetna Commercial |
$1,559.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,490.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$918.30
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$1,594.03
|
| Rate for Payer: Health EOS Commercial |
$1,542.05
|
| Rate for Payer: HFN Commercial |
$1,594.03
|
| Rate for Payer: Multiplan Commercial |
$1,386.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,594.03
|
| Rate for Payer: Quartz Beloit One Network |
$848.99
|
| Rate for Payer: Quartz Commercial |
$1,039.58
|
| Rate for Payer: WEA Trust Commercial |
$952.95
|
| Rate for Payer: WPS Commercial |
$1,283.32
|
|
|
CATHETER DRAINAGE 12fr ANGIOTE #756512025
|
Facility
|
OP
|
$1,666.00
|
|
| Hospital Charge Code |
2973596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$1,594.03 |
| Rate for Payer: Aetna Commercial |
$1,559.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,490.07
|
| Rate for Payer: Aetna Managed Medicare |
$485.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,126.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$866.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$831.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$918.30
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$1,594.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$969.61
|
| Rate for Payer: Health EOS Commercial |
$1,542.05
|
| Rate for Payer: HFN Commercial |
$1,594.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.48
|
| Rate for Payer: Multiplan Commercial |
$1,386.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,039.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,594.03
|
| Rate for Payer: Quartz Beloit One Network |
$848.99
|
| Rate for Payer: Quartz Commercial |
$1,126.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,039.58
|
| Rate for Payer: The Alliance Commercial |
$866.32
|
| Rate for Payer: WEA Trust Commercial |
$952.95
|
| Rate for Payer: WPS Commercial |
$1,283.32
|
|
|
CATHETER DUAL SENSOR 7F W/FILL #T-DOC-7FD
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
2973496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.49 |
| Max. Negotiated Rate |
$708.03 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.86
|
| Rate for Payer: Aetna Managed Medicare |
$215.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$500.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$369.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.89
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$708.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.68
|
| Rate for Payer: Health EOS Commercial |
$684.94
|
| Rate for Payer: HFN Commercial |
$708.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$577.20
|
| Rate for Payer: Multiplan Commercial |
$615.68
|
| Rate for Payer: NAPHCARE Commercial |
$461.76
|
| Rate for Payer: Preferred Network Access Commercial |
$708.03
|
| Rate for Payer: Quartz Beloit One Network |
$377.10
|
| Rate for Payer: Quartz Commercial |
$500.24
|
| Rate for Payer: Quartz Medicare Advantage |
$461.76
|
| Rate for Payer: The Alliance Commercial |
$384.80
|
| Rate for Payer: WEA Trust Commercial |
$423.28
|
| Rate for Payer: WPS Commercial |
$570.02
|
|
