|
CATHETER DUAL SENSOR 7F W/FILL #T-DOC-7FD
|
Facility
|
IP
|
$740.00
|
|
| Hospital Charge Code |
2973496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.10 |
| Max. Negotiated Rate |
$708.03 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.86
|
| 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: Health EOS Commercial |
$684.94
|
| Rate for Payer: HFN Commercial |
$708.03
|
| Rate for Payer: Multiplan Commercial |
$615.68
|
| Rate for Payer: Preferred Network Access Commercial |
$708.03
|
| Rate for Payer: Quartz Beloit One Network |
$377.10
|
| Rate for Payer: Quartz Commercial |
$461.76
|
| Rate for Payer: WEA Trust Commercial |
$423.28
|
| Rate for Payer: WPS Commercial |
$570.02
|
|
|
CATHETER EBU GUIDE 3.0 LA6EBU30
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Aetna Managed Medicare |
$282.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$656.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$504.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$484.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.12
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.38
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: NAPHCARE Commercial |
$605.90
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$656.40
|
| Rate for Payer: Quartz Medicare Advantage |
$605.90
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
CATHETER EBU GUIDE 3.0 LA6EBU30
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.82 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$605.90
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
CATHETER EBU GUIDE 3.5 LA6EBU35
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.82 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$605.90
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
CATHETER EBU GUIDE 3.5 LA6EBU35
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Aetna Managed Medicare |
$282.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$656.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$504.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$484.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.12
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.38
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: NAPHCARE Commercial |
$605.90
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$656.40
|
| Rate for Payer: Quartz Medicare Advantage |
$605.90
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
CATHETER EBU GUIDE 4.0 LA6EBU40
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Aetna Managed Medicare |
$282.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$656.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$504.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$484.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.12
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.38
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: NAPHCARE Commercial |
$605.90
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$656.40
|
| Rate for Payer: Quartz Medicare Advantage |
$605.90
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
CATHETER EBU GUIDE 4.0 LA6EBU40
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3435505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.82 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$605.90
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
CATHETER EMBOLECTOMY 2FR A4F00
|
Facility
|
OP
|
$1,298.00
|
|
| Hospital Charge Code |
2964650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.98 |
| Max. Negotiated Rate |
$1,241.93 |
| Rate for Payer: Aetna Commercial |
$1,214.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Aetna Managed Medicare |
$377.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$877.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.46
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,241.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$755.44
|
| Rate for Payer: Health EOS Commercial |
$1,201.43
|
| Rate for Payer: HFN Commercial |
$1,241.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,012.44
|
| Rate for Payer: Multiplan Commercial |
$1,079.94
|
| Rate for Payer: NAPHCARE Commercial |
$809.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.93
|
| Rate for Payer: Quartz Beloit One Network |
$661.46
|
| Rate for Payer: Quartz Commercial |
$877.45
|
| Rate for Payer: Quartz Medicare Advantage |
$809.95
|
| Rate for Payer: The Alliance Commercial |
$674.96
|
| Rate for Payer: WEA Trust Commercial |
$742.46
|
| Rate for Payer: WPS Commercial |
$999.85
|
|
|
CATHETER EMBOLECTOMY 2FR A4F00
|
Facility
|
IP
|
$1,298.00
|
|
| Hospital Charge Code |
2964650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.46 |
| Max. Negotiated Rate |
$1,241.93 |
| Rate for Payer: Aetna Commercial |
$1,214.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.46
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,241.93
|
| Rate for Payer: Health EOS Commercial |
$1,201.43
|
| Rate for Payer: HFN Commercial |
$1,241.93
|
| Rate for Payer: Multiplan Commercial |
$1,079.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.93
|
| Rate for Payer: Quartz Beloit One Network |
$661.46
|
| Rate for Payer: Quartz Commercial |
$809.95
|
| Rate for Payer: WEA Trust Commercial |
$742.46
|
| Rate for Payer: WPS Commercial |
$999.85
|
|
|
CATHETER EMBOLECTOMY 3FR A4403/E1801-38
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.21 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$904.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.26
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna Commercial |
$967.32
|
| Rate for Payer: Health EOS Commercial |
$935.78
|
| Rate for Payer: HFN Commercial |
$967.32
|
| Rate for Payer: Multiplan Commercial |
$841.15
|
| Rate for Payer: Preferred Network Access Commercial |
$967.32
|
| Rate for Payer: Quartz Beloit One Network |
$515.21
|
| Rate for Payer: Quartz Commercial |
$630.86
|
| Rate for Payer: WEA Trust Commercial |
$578.29
|
| Rate for Payer: WPS Commercial |
$778.77
|
|
|
CATHETER EMBOLECTOMY 3FR A4403/E1801-38
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$904.24
|
| Rate for Payer: Aetna Managed Medicare |
$294.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$683.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.26
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna Commercial |
$967.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.40
|
| Rate for Payer: Health EOS Commercial |
$935.78
|
| Rate for Payer: HFN Commercial |
$967.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.58
|
| Rate for Payer: Multiplan Commercial |
$841.15
|
| Rate for Payer: NAPHCARE Commercial |
$630.86
|
| Rate for Payer: Preferred Network Access Commercial |
$967.32
|
| Rate for Payer: Quartz Beloit One Network |
$515.21
|
| Rate for Payer: Quartz Commercial |
$683.44
|
| Rate for Payer: Quartz Medicare Advantage |
$630.86
|
| Rate for Payer: The Alliance Commercial |
$525.72
|
| Rate for Payer: WEA Trust Commercial |
$578.29
|
| Rate for Payer: WPS Commercial |
$778.77
|
|
|
CATHETER EMBOLECTOMY 4FR A4548
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Aetna Managed Medicare |
$364.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$845.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$650.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$727.50
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$845.00
|
| Rate for Payer: Quartz Medicare Advantage |
$780.00
|
| Rate for Payer: The Alliance Commercial |
$650.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
CATHETER EMBOLECTOMY 4FR A4548
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$780.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
CATHETER EMMETT 26FR 30CC 3-WAY 0138L26
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
5414944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
CATHETER EMMETT 26FR 30CC 3-WAY 0138L26
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
5414944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
CATHETER EPISTAXIS 20-10701
|
Facility
|
OP
|
$986.00
|
|
| Hospital Charge Code |
2963459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.12 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Aetna Managed Medicare |
$287.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.85
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$769.08
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: NAPHCARE Commercial |
$615.26
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$666.54
|
| Rate for Payer: Quartz Medicare Advantage |
$615.26
|
| Rate for Payer: The Alliance Commercial |
$512.72
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
|
CATHETER EPISTAXIS 20-10701
|
Facility
|
IP
|
$986.00
|
|
| Hospital Charge Code |
2963459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.47 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$615.26
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
|
CATHETER ERCP
|
Facility
|
OP
|
$1,138.00
|
|
| Hospital Charge Code |
2963461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.39 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Aetna Managed Medicare |
$331.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.32
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.64
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: NAPHCARE Commercial |
$710.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$769.29
|
| Rate for Payer: Quartz Medicare Advantage |
$710.11
|
| Rate for Payer: The Alliance Commercial |
$591.76
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
CATHETER ERCP
|
Facility
|
IP
|
$1,138.00
|
|
| Hospital Charge Code |
2963461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$710.11
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
CATHETER EXCHANGE, DIALYSIS
|
Facility
|
IP
|
$1,872.00
|
|
| Hospital Charge Code |
6209793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$953.97 |
| Max. Negotiated Rate |
$1,791.13 |
| Rate for Payer: Aetna Commercial |
$1,752.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.85
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,791.13
|
| Rate for Payer: Health EOS Commercial |
$1,732.72
|
| Rate for Payer: HFN Commercial |
$1,791.13
|
| Rate for Payer: Multiplan Commercial |
$1,557.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.13
|
| Rate for Payer: Quartz Beloit One Network |
$953.97
|
| Rate for Payer: Quartz Commercial |
$1,168.13
|
| Rate for Payer: WEA Trust Commercial |
$1,070.78
|
| Rate for Payer: WPS Commercial |
$1,442.00
|
|
|
CATHETER EXCHANGE, DIALYSIS
|
Facility
|
OP
|
$1,872.00
|
|
| Hospital Charge Code |
6209793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$545.13 |
| Max. Negotiated Rate |
$1,791.13 |
| Rate for Payer: Aetna Commercial |
$1,752.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.32
|
| Rate for Payer: Aetna Managed Medicare |
$545.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.85
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,791.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.50
|
| Rate for Payer: Health EOS Commercial |
$1,732.72
|
| Rate for Payer: HFN Commercial |
$1,791.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.16
|
| Rate for Payer: Multiplan Commercial |
$1,557.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.13
|
| Rate for Payer: Quartz Beloit One Network |
$953.97
|
| Rate for Payer: Quartz Commercial |
$1,265.47
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.13
|
| Rate for Payer: The Alliance Commercial |
$973.44
|
| Rate for Payer: WEA Trust Commercial |
$1,070.78
|
| Rate for Payer: WPS Commercial |
$1,442.00
|
|
|
CATHETER FOLEY 10FR 3cc I.C 0165SI10
|
Facility
|
OP
|
$263.00
|
|
| Hospital Charge Code |
2963280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$76.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.07
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$164.11
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$177.79
|
| Rate for Payer: Quartz Medicare Advantage |
$164.11
|
| Rate for Payer: The Alliance Commercial |
$136.76
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
CATHETER FOLEY 10FR 3cc I.C 0165SI10
|
Facility
|
IP
|
$263.00
|
|
| Hospital Charge Code |
2963280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$164.11
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
CATHETER FOLEY 12FR 5CC 2-WAY BARDEX 0165SI12
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$72.72
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
CATHETER FOLEY 12FR 5CC 2-WAY BARDEX 0165SI12
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
