|
CATHETER GUIDE SLITTER
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
2971460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
CATHETER GUIDE SLITTER
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
2971460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
CATHETER GUIDEZILLA GUIDE 39242-1505
|
Facility
|
OP
|
$5,077.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3331522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.42 |
| Max. Negotiated Rate |
$4,857.67 |
| Rate for Payer: Aetna Commercial |
$4,752.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,540.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,478.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,432.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,640.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,534.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,798.44
|
| Rate for Payer: Cash Price |
$1,523.10
|
| Rate for Payer: Cigna Commercial |
$4,857.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,954.81
|
| Rate for Payer: Health EOS Commercial |
$4,699.27
|
| Rate for Payer: HFN Commercial |
$4,857.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,960.06
|
| Rate for Payer: Multiplan Commercial |
$4,224.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,168.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,857.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.24
|
| Rate for Payer: Quartz Commercial |
$3,432.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,168.05
|
| Rate for Payer: The Alliance Commercial |
$2,640.04
|
| Rate for Payer: WEA Trust Commercial |
$2,904.04
|
| Rate for Payer: WPS Commercial |
$3,910.81
|
|
|
CATHETER GUIDEZILLA GUIDE 39242-1505
|
Facility
|
IP
|
$5,077.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3331522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,587.24 |
| Max. Negotiated Rate |
$4,857.67 |
| Rate for Payer: Aetna Commercial |
$4,752.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,540.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,798.44
|
| Rate for Payer: Cash Price |
$1,523.10
|
| Rate for Payer: Cigna Commercial |
$4,857.67
|
| Rate for Payer: Health EOS Commercial |
$4,699.27
|
| Rate for Payer: HFN Commercial |
$4,857.67
|
| Rate for Payer: Multiplan Commercial |
$4,224.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,857.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.24
|
| Rate for Payer: Quartz Commercial |
$3,168.05
|
| Rate for Payer: WEA Trust Commercial |
$2,904.04
|
| Rate for Payer: WPS Commercial |
$3,910.81
|
|
|
CATHETER GUIDING 7fr HS 77827855
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$948.88 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,161.89
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
CATHETER GUIDING 7fr HS 77827855
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.21 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Aetna Managed Medicare |
$542.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,258.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$968.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$929.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.68
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,452.36
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,161.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,258.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,161.89
|
| Rate for Payer: The Alliance Commercial |
$968.24
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
CATHETER GUIDING 7 FR RDC 77821255
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$948.88 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,161.89
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
CATHETER GUIDING 7 FR RDC 77821255
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.21 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Aetna Managed Medicare |
$542.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,258.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$968.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$929.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.68
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,452.36
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,161.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,258.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,161.89
|
| Rate for Payer: The Alliance Commercial |
$968.24
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
CATHETER GUIDING 8FR. HS 588841P
|
Facility
|
IP
|
$1,303.00
|
|
| Hospital Charge Code |
2972161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.01 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$813.07
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
CATHETER GUIDING 8FR. HS 588841P
|
Facility
|
OP
|
$1,303.00
|
|
| Hospital Charge Code |
2972161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.43 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Aetna Managed Medicare |
$379.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.35
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.34
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: NAPHCARE Commercial |
$813.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$880.83
|
| Rate for Payer: Quartz Medicare Advantage |
$813.07
|
| Rate for Payer: The Alliance Commercial |
$677.56
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
CATHETER HALO EXPRESS RFA BALLOON 64082
|
Facility
|
IP
|
$1,368.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
5106627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.13 |
| Max. Negotiated Rate |
$1,308.90 |
| Rate for Payer: Aetna Commercial |
$1,280.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,223.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.04
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna Commercial |
$1,308.90
|
| Rate for Payer: Health EOS Commercial |
$1,266.22
|
| Rate for Payer: HFN Commercial |
$1,308.90
|
| Rate for Payer: Multiplan Commercial |
$1,138.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,308.90
|
| Rate for Payer: Quartz Beloit One Network |
$697.13
|
| Rate for Payer: Quartz Commercial |
$853.63
|
| Rate for Payer: WEA Trust Commercial |
$782.50
|
| Rate for Payer: WPS Commercial |
$1,053.77
|
|
|
CATHETER HALO EXPRESS RFA BALLOON 64082
|
Facility
|
OP
|
$1,368.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
5106627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.36 |
| Max. Negotiated Rate |
$1,308.90 |
| Rate for Payer: Aetna Commercial |
$1,280.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,223.54
|
| Rate for Payer: Aetna Managed Medicare |
$398.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$924.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$711.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$682.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.04
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna Commercial |
$1,308.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.18
|
| Rate for Payer: Health EOS Commercial |
$1,266.22
|
| Rate for Payer: HFN Commercial |
$1,308.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,067.04
|
| Rate for Payer: Multiplan Commercial |
$1,138.18
|
| Rate for Payer: NAPHCARE Commercial |
$853.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,308.90
|
| Rate for Payer: Quartz Beloit One Network |
$697.13
|
| Rate for Payer: Quartz Commercial |
$924.77
|
| Rate for Payer: Quartz Medicare Advantage |
$853.63
|
| Rate for Payer: The Alliance Commercial |
$711.36
|
| Rate for Payer: WEA Trust Commercial |
$782.50
|
| Rate for Payer: WPS Commercial |
$1,053.77
|
|
|
CATHETER HALO RFA CHANNEL TTS-1100
|
Facility
|
OP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4147208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
CATHETER HALO RFA CHANNEL TTS-1100
|
Facility
|
IP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4147208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
CATHETER - INDWELLING/CONTINUOUS* 51702
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6031631
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.21
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$242.68
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$280.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
CATHETER - INDWELLING/CONTINUOUS* 51702
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6031631
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$182.95 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$224.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
CATHETER INDWELLING SLIT SET 295-6
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2962861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.55 |
| Max. Negotiated Rate |
$1,101.28 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$718.22
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
CATHETER INDWELLING SLIT SET 295-6
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2962861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.17 |
| Max. Negotiated Rate |
$1,101.28 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Aetna Managed Medicare |
$335.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$598.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$574.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$669.88
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.78
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: NAPHCARE Commercial |
$718.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$778.08
|
| Rate for Payer: Quartz Medicare Advantage |
$718.22
|
| Rate for Payer: The Alliance Commercial |
$598.52
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
CATHETER INFUSION 5FR 41058-01 135CM X 30CM
|
Facility
|
IP
|
$1,991.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
3493524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.61 |
| Max. Negotiated Rate |
$1,904.99 |
| Rate for Payer: Aetna Commercial |
$1,863.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,097.44
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,904.99
|
| Rate for Payer: Health EOS Commercial |
$1,842.87
|
| Rate for Payer: HFN Commercial |
$1,904.99
|
| Rate for Payer: Multiplan Commercial |
$1,656.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,904.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.61
|
| Rate for Payer: Quartz Commercial |
$1,242.38
|
| Rate for Payer: WEA Trust Commercial |
$1,138.85
|
| Rate for Payer: WPS Commercial |
$1,533.67
|
|
|
CATHETER INFUSION 5FR 41058-01 135CM X 30CM
|
Facility
|
OP
|
$1,991.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
3493524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.78 |
| Max. Negotiated Rate |
$1,904.99 |
| Rate for Payer: Aetna Commercial |
$1,863.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.75
|
| Rate for Payer: Aetna Managed Medicare |
$579.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,345.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,035.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$993.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,097.44
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,904.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,158.76
|
| Rate for Payer: Health EOS Commercial |
$1,842.87
|
| Rate for Payer: HFN Commercial |
$1,904.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,552.98
|
| Rate for Payer: Multiplan Commercial |
$1,656.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,242.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,904.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.61
|
| Rate for Payer: Quartz Commercial |
$1,345.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,242.38
|
| Rate for Payer: The Alliance Commercial |
$1,035.32
|
| Rate for Payer: WEA Trust Commercial |
$1,138.85
|
| Rate for Payer: WPS Commercial |
$1,533.67
|
|
|
CATHETER INSERTION, BROVIAC
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959909
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CATHETER INSERTION, BROVIAC
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959909
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CATHETER INSERTION, DIALYSIS
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CATHETER INSERTION, DIALYSIS
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CATHETER INSERTION, HICKMAN
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959911
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
