|
CATHETER PICC SINGLE 5 FR.
|
Facility
|
IP
|
$1,104.00
|
|
| Hospital Charge Code |
2963296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.96 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$662.40
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
CATHETER PICC SINGLE 5 FR.
|
Facility
|
OP
|
$1,104.00
|
|
| Hospital Charge Code |
2963296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.12 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Aetna Managed Medicare |
$309.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$717.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$552.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.80
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.00
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$717.60
|
| Rate for Payer: Quartz Medicare Advantage |
$662.40
|
| Rate for Payer: The Alliance Commercial |
$4,416.00
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
CATHETER PIG 5fr
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
2971167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Aetna Managed Medicare |
$128.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.42
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$299.00
|
| Rate for Payer: Quartz Medicare Advantage |
$276.00
|
| Rate for Payer: The Alliance Commercial |
$1,840.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
CATHETER PIG 5fr
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
2971167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
CATHETER REMOVAL, DIALYSIS
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
6209794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.12 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
CATHETER REMOVAL, DIALYSIS
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
6209794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$276.64 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$276.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$552.88
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$642.20
|
| Rate for Payer: Quartz Medicare Advantage |
$592.80
|
| Rate for Payer: The Alliance Commercial |
$3,952.00
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
CATHETER RFA 90 ULTRA LONG FOCAL 90-9200
|
Facility
|
IP
|
$10,774.00
|
|
| Hospital Charge Code |
4147207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,279.26 |
| Max. Negotiated Rate |
$9,912.08 |
| Rate for Payer: Aetna Commercial |
$9,696.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,710.22
|
| Rate for Payer: Cash Price |
$3,232.20
|
| Rate for Payer: Cigna Commercial |
$9,912.08
|
| Rate for Payer: Health EOS Commercial |
$9,588.86
|
| Rate for Payer: HFN Commercial |
$9,912.08
|
| Rate for Payer: Multiplan Commercial |
$8,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,464.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,912.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,279.26
|
| Rate for Payer: Quartz Commercial |
$6,464.40
|
| Rate for Payer: WEA Trust Commercial |
$5,925.70
|
| Rate for Payer: WPS Commercial |
$7,980.30
|
|
|
CATHETER RFA 90 ULTRA LONG FOCAL 90-9200
|
Facility
|
OP
|
$10,774.00
|
|
| Hospital Charge Code |
4147207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,016.72 |
| Max. Negotiated Rate |
$43,096.00 |
| Rate for Payer: Aetna Commercial |
$9,696.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,265.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,016.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,003.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,387.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,171.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,710.22
|
| Rate for Payer: Cash Price |
$3,232.20
|
| Rate for Payer: Cigna Commercial |
$9,912.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,029.13
|
| Rate for Payer: Health EOS Commercial |
$9,588.86
|
| Rate for Payer: HFN Commercial |
$9,912.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,080.50
|
| Rate for Payer: Multiplan Commercial |
$8,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,464.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,912.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,279.26
|
| Rate for Payer: Quartz Commercial |
$7,003.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6,464.40
|
| Rate for Payer: The Alliance Commercial |
$43,096.00
|
| Rate for Payer: WEA Trust Commercial |
$5,925.70
|
| Rate for Payer: WPS Commercial |
$7,980.30
|
|
|
CATHETER ROTALINK PLUS 1.25mm 23631-002
|
Facility
|
IP
|
$4,547.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,228.03 |
| Max. Negotiated Rate |
$4,183.24 |
| Rate for Payer: Aetna Commercial |
$4,092.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,910.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,409.91
|
| Rate for Payer: Cash Price |
$1,364.10
|
| Rate for Payer: Cigna Commercial |
$4,183.24
|
| Rate for Payer: Health EOS Commercial |
$4,046.83
|
| Rate for Payer: HFN Commercial |
$4,183.24
|
| Rate for Payer: Multiplan Commercial |
$3,637.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,183.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.03
|
| Rate for Payer: Quartz Commercial |
$2,728.20
|
| Rate for Payer: WEA Trust Commercial |
$2,500.85
|
| Rate for Payer: WPS Commercial |
$3,367.96
|
|
|
CATHETER ROTALINK PLUS 1.25mm 23631-002
|
Facility
|
OP
|
$4,547.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,273.16 |
| Max. Negotiated Rate |
$18,188.00 |
| Rate for Payer: Aetna Commercial |
$4,092.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,910.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,273.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,955.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,182.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,409.91
|
| Rate for Payer: Cash Price |
$1,364.10
|
| Rate for Payer: Cigna Commercial |
$4,183.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,544.50
|
| Rate for Payer: Health EOS Commercial |
$4,046.83
|
| Rate for Payer: HFN Commercial |
$4,183.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,410.25
|
| Rate for Payer: Multiplan Commercial |
$3,637.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,183.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.03
|
| Rate for Payer: Quartz Commercial |
$2,955.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,728.20
|
| Rate for Payer: The Alliance Commercial |
$18,188.00
|
| Rate for Payer: WEA Trust Commercial |
$2,500.85
|
| Rate for Payer: WPS Commercial |
$3,367.96
|
|
|
CATHETER ROTALINK PLUS 1.5mm 23631-003
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,226.12 |
| Max. Negotiated Rate |
$17,516.00 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,846.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,101.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,450.49
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,284.25
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,846.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,627.40
|
| Rate for Payer: The Alliance Commercial |
$17,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 1.5mm 23631-003
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.71 |
| Max. Negotiated Rate |
$4,028.68 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,627.40
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 1.75mm 23631-004
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.71 |
| Max. Negotiated Rate |
$4,028.68 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,627.40
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 1.75mm 23631-004
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,226.12 |
| Max. Negotiated Rate |
$17,516.00 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,846.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,101.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,450.49
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,284.25
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,846.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,627.40
|
| Rate for Payer: The Alliance Commercial |
$17,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.00mm 23631-005
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.71 |
| Max. Negotiated Rate |
$4,028.68 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,627.40
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.00mm 23631-005
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,226.12 |
| Max. Negotiated Rate |
$17,516.00 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,846.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,101.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,450.49
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,284.25
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,846.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,627.40
|
| Rate for Payer: The Alliance Commercial |
$17,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.15mm 23631-015
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.71 |
| Max. Negotiated Rate |
$4,028.68 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,627.40
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.15mm 23631-015
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,226.12 |
| Max. Negotiated Rate |
$17,516.00 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,846.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,101.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,450.49
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,284.25
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,846.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,627.40
|
| Rate for Payer: The Alliance Commercial |
$17,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.25mm 23631-006
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.71 |
| Max. Negotiated Rate |
$4,028.68 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,627.40
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.25mm 23631-006
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,226.12 |
| Max. Negotiated Rate |
$17,516.00 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,846.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,101.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,450.49
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,284.25
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,846.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,627.40
|
| Rate for Payer: The Alliance Commercial |
$17,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.38mm 23631-016
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,226.12 |
| Max. Negotiated Rate |
$17,516.00 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,846.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,101.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,450.49
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,284.25
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,846.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,627.40
|
| Rate for Payer: The Alliance Commercial |
$17,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER ROTALINK PLUS 2.38mm 23631-016
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,145.71 |
| Max. Negotiated Rate |
$4,028.68 |
| Rate for Payer: Aetna Commercial |
$3,941.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,765.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,320.87
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,028.68
|
| Rate for Payer: Health EOS Commercial |
$3,897.31
|
| Rate for Payer: HFN Commercial |
$4,028.68
|
| Rate for Payer: Multiplan Commercial |
$3,503.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,627.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,145.71
|
| Rate for Payer: Quartz Commercial |
$2,627.40
|
| Rate for Payer: WEA Trust Commercial |
$2,408.45
|
| Rate for Payer: WPS Commercial |
$3,243.53
|
|
|
CATHETER RUSCH14FR 5-15ML 2-WAY COUDE 318114
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS A4353
|
| Hospital Charge Code |
2963369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$784.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
CATHETER RUSCH14FR 5-15ML 2-WAY COUDE 318114
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS A4353
|
| Hospital Charge Code |
2963369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
CATHETER SHOLKOFF BALLOON 6.8F #J-SBH-683000***DISC 4/17
|
Facility
|
OP
|
$1,046.00
|
|
| Hospital Charge Code |
2971965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.88 |
| Max. Negotiated Rate |
$4,184.00 |
| Rate for Payer: Aetna Commercial |
$941.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.56
|
| Rate for Payer: Aetna Managed Medicare |
$292.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$679.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.38
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$962.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.34
|
| Rate for Payer: Health EOS Commercial |
$930.94
|
| Rate for Payer: HFN Commercial |
$962.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.50
|
| Rate for Payer: Multiplan Commercial |
$836.80
|
| Rate for Payer: NAPHCARE Commercial |
$627.60
|
| Rate for Payer: Preferred Network Access Commercial |
$962.32
|
| Rate for Payer: Quartz Beloit One Network |
$512.54
|
| Rate for Payer: Quartz Commercial |
$679.90
|
| Rate for Payer: Quartz Medicare Advantage |
$627.60
|
| Rate for Payer: The Alliance Commercial |
$4,184.00
|
| Rate for Payer: WEA Trust Commercial |
$575.30
|
| Rate for Payer: WPS Commercial |
$774.77
|
|
