|
CATHETER OPEN END 6FR G15942
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
2965856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
CATHETER OPEN END 6FR G15942
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
2965856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
CATHETER OPTI-Q SvO2 52509-14
|
Facility
|
OP
|
$3,016.00
|
|
| Hospital Charge Code |
2963033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.26 |
| Max. Negotiated Rate |
$2,885.71 |
| Rate for Payer: Aetna Commercial |
$2,822.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.51
|
| Rate for Payer: Aetna Managed Medicare |
$878.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,038.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.42
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cigna Commercial |
$2,885.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.31
|
| Rate for Payer: Health EOS Commercial |
$2,791.61
|
| Rate for Payer: HFN Commercial |
$2,885.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.48
|
| Rate for Payer: Multiplan Commercial |
$2,509.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,881.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,885.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.95
|
| Rate for Payer: Quartz Commercial |
$2,038.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,881.98
|
| Rate for Payer: The Alliance Commercial |
$1,568.32
|
| Rate for Payer: WEA Trust Commercial |
$1,725.15
|
| Rate for Payer: WPS Commercial |
$2,323.22
|
|
|
CATHETER OPTI-Q SvO2 52509-14
|
Facility
|
IP
|
$3,016.00
|
|
| Hospital Charge Code |
2963033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,536.95 |
| Max. Negotiated Rate |
$2,885.71 |
| Rate for Payer: Aetna Commercial |
$2,822.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.42
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cigna Commercial |
$2,885.71
|
| Rate for Payer: Health EOS Commercial |
$2,791.61
|
| Rate for Payer: HFN Commercial |
$2,885.71
|
| Rate for Payer: Multiplan Commercial |
$2,509.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,885.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.95
|
| Rate for Payer: Quartz Commercial |
$1,881.98
|
| Rate for Payer: WEA Trust Commercial |
$1,725.15
|
| Rate for Payer: WPS Commercial |
$2,323.22
|
|
|
CATHETER PERIFIX OPEN TIP EC200 333520
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
5520794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CATHETER PERIFIX OPEN TIP EC200 333520
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
5520794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$54.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| Rate for Payer: Quartz Medicare Advantage |
$117.31
|
| Rate for Payer: The Alliance Commercial |
$97.76
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CATHETER PHIL FOLLOWER 22F
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2963085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
CATHETER PHIL FOLLOWER 22F
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2963085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
CATHETER PICC PWRD DOUBLE 5 FR. 3275355F
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2962940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Aetna Managed Medicare |
$423.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$983.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.81
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: NAPHCARE Commercial |
$907.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$983.58
|
| Rate for Payer: Quartz Medicare Advantage |
$907.92
|
| Rate for Payer: The Alliance Commercial |
$756.60
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
CATHETER PICC PWRD DOUBLE 5 FR. 3275355F
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2962940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$741.47 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
CATHETER PICC SINGLE 5 FR.
|
Facility
|
OP
|
$1,104.00
|
|
| Hospital Charge Code |
2963296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.48 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$321.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.53
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: Quartz Medicare Advantage |
$688.90
|
| Rate for Payer: The Alliance Commercial |
$574.08
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
CATHETER PICC SINGLE 5 FR.
|
Facility
|
IP
|
$1,104.00
|
|
| Hospital Charge Code |
2963296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$688.90
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
CATHETER PIG 5fr
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
2971167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.95 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Aetna Managed Medicare |
$133.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: NAPHCARE Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$310.96
|
| Rate for Payer: Quartz Medicare Advantage |
$287.04
|
| Rate for Payer: The Alliance Commercial |
$239.20
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
CATHETER PIG 5fr
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
2971167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
CATHETER REMOVAL, DIALYSIS
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
6209794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
CATHETER REMOVAL, DIALYSIS
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
6209794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$287.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.02
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$616.51
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$616.51
|
| Rate for Payer: The Alliance Commercial |
$513.76
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
CATHETER RFA 90 ULTRA LONG FOCAL 90-9200
|
Facility
|
IP
|
$10,774.00
|
|
| Hospital Charge Code |
4147207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,490.43 |
| Max. Negotiated Rate |
$10,308.56 |
| Rate for Payer: Aetna Commercial |
$10,084.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,636.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,938.63
|
| Rate for Payer: Cash Price |
$3,232.20
|
| Rate for Payer: Cigna Commercial |
$10,308.56
|
| Rate for Payer: Health EOS Commercial |
$9,972.41
|
| Rate for Payer: HFN Commercial |
$10,308.56
|
| Rate for Payer: Multiplan Commercial |
$8,963.97
|
| Rate for Payer: Preferred Network Access Commercial |
$10,308.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,490.43
|
| Rate for Payer: Quartz Commercial |
$6,722.98
|
| Rate for Payer: WEA Trust Commercial |
$6,162.73
|
| Rate for Payer: WPS Commercial |
$8,299.21
|
|
|
CATHETER RFA 90 ULTRA LONG FOCAL 90-9200
|
Facility
|
OP
|
$10,774.00
|
|
| Hospital Charge Code |
4147207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,137.39 |
| Max. Negotiated Rate |
$10,308.56 |
| Rate for Payer: Aetna Commercial |
$10,084.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,636.27
|
| Rate for Payer: Aetna Managed Medicare |
$3,137.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,283.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,602.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,378.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,938.63
|
| Rate for Payer: Cash Price |
$3,232.20
|
| Rate for Payer: Cigna Commercial |
$10,308.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,270.47
|
| Rate for Payer: Health EOS Commercial |
$9,972.41
|
| Rate for Payer: HFN Commercial |
$10,308.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,403.72
|
| Rate for Payer: Multiplan Commercial |
$8,963.97
|
| Rate for Payer: NAPHCARE Commercial |
$6,722.98
|
| Rate for Payer: Preferred Network Access Commercial |
$10,308.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,490.43
|
| Rate for Payer: Quartz Commercial |
$7,283.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6,722.98
|
| Rate for Payer: The Alliance Commercial |
$5,602.48
|
| Rate for Payer: WEA Trust Commercial |
$6,162.73
|
| Rate for Payer: WPS Commercial |
$8,299.21
|
|
|
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 |
$2,317.15 |
| Max. Negotiated Rate |
$4,350.57 |
| Rate for Payer: Aetna Commercial |
$4,255.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,066.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,506.31
|
| Rate for Payer: Cash Price |
$1,364.10
|
| Rate for Payer: Cigna Commercial |
$4,350.57
|
| Rate for Payer: Health EOS Commercial |
$4,208.70
|
| Rate for Payer: HFN Commercial |
$4,350.57
|
| Rate for Payer: Multiplan Commercial |
$3,783.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,350.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,317.15
|
| Rate for Payer: Quartz Commercial |
$2,837.33
|
| Rate for Payer: WEA Trust Commercial |
$2,600.88
|
| Rate for Payer: WPS Commercial |
$3,502.55
|
|
|
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 |
$1,324.09 |
| Max. Negotiated Rate |
$4,350.57 |
| Rate for Payer: Aetna Commercial |
$4,255.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,066.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,324.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,073.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,364.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,269.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,506.31
|
| Rate for Payer: Cash Price |
$1,364.10
|
| Rate for Payer: Cigna Commercial |
$4,350.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,646.35
|
| Rate for Payer: Health EOS Commercial |
$4,208.70
|
| Rate for Payer: HFN Commercial |
$4,350.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,546.66
|
| Rate for Payer: Multiplan Commercial |
$3,783.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,837.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,350.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,317.15
|
| Rate for Payer: Quartz Commercial |
$3,073.77
|
| Rate for Payer: Quartz Medicare Advantage |
$2,837.33
|
| Rate for Payer: The Alliance Commercial |
$2,364.44
|
| Rate for Payer: WEA Trust Commercial |
$2,600.88
|
| Rate for Payer: WPS Commercial |
$3,502.55
|
|
|
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 |
$2,231.54 |
| Max. Negotiated Rate |
$4,189.83 |
| Rate for Payer: Aetna Commercial |
$4,098.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,916.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.70
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,189.83
|
| Rate for Payer: Health EOS Commercial |
$4,053.20
|
| Rate for Payer: HFN Commercial |
$4,189.83
|
| Rate for Payer: Multiplan Commercial |
$3,643.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,189.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,231.54
|
| Rate for Payer: Quartz Commercial |
$2,732.50
|
| Rate for Payer: WEA Trust Commercial |
$2,504.79
|
| Rate for Payer: WPS Commercial |
$3,373.14
|
|
|
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 |
$1,275.16 |
| Max. Negotiated Rate |
$4,189.83 |
| Rate for Payer: Aetna Commercial |
$4,098.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,916.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,275.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,960.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,277.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,186.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.70
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,189.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,548.58
|
| Rate for Payer: Health EOS Commercial |
$4,053.20
|
| Rate for Payer: HFN Commercial |
$4,189.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,415.62
|
| Rate for Payer: Multiplan Commercial |
$3,643.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,732.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,189.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,231.54
|
| Rate for Payer: Quartz Commercial |
$2,960.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,732.50
|
| Rate for Payer: The Alliance Commercial |
$2,277.08
|
| Rate for Payer: WEA Trust Commercial |
$2,504.79
|
| Rate for Payer: WPS Commercial |
$3,373.14
|
|
|
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 |
$2,231.54 |
| Max. Negotiated Rate |
$4,189.83 |
| Rate for Payer: Aetna Commercial |
$4,098.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,916.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.70
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,189.83
|
| Rate for Payer: Health EOS Commercial |
$4,053.20
|
| Rate for Payer: HFN Commercial |
$4,189.83
|
| Rate for Payer: Multiplan Commercial |
$3,643.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,189.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,231.54
|
| Rate for Payer: Quartz Commercial |
$2,732.50
|
| Rate for Payer: WEA Trust Commercial |
$2,504.79
|
| Rate for Payer: WPS Commercial |
$3,373.14
|
|
|
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 |
$1,275.16 |
| Max. Negotiated Rate |
$4,189.83 |
| Rate for Payer: Aetna Commercial |
$4,098.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,916.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,275.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,960.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,277.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,186.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.70
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,189.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,548.58
|
| Rate for Payer: Health EOS Commercial |
$4,053.20
|
| Rate for Payer: HFN Commercial |
$4,189.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,415.62
|
| Rate for Payer: Multiplan Commercial |
$3,643.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,732.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,189.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,231.54
|
| Rate for Payer: Quartz Commercial |
$2,960.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,732.50
|
| Rate for Payer: The Alliance Commercial |
$2,277.08
|
| Rate for Payer: WEA Trust Commercial |
$2,504.79
|
| Rate for Payer: WPS Commercial |
$3,373.14
|
|
|
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 |
$1,275.16 |
| Max. Negotiated Rate |
$4,189.83 |
| Rate for Payer: Aetna Commercial |
$4,098.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,916.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,275.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,960.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,277.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,186.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.70
|
| Rate for Payer: Cash Price |
$1,313.70
|
| Rate for Payer: Cigna Commercial |
$4,189.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,548.58
|
| Rate for Payer: Health EOS Commercial |
$4,053.20
|
| Rate for Payer: HFN Commercial |
$4,189.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,415.62
|
| Rate for Payer: Multiplan Commercial |
$3,643.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,732.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,189.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,231.54
|
| Rate for Payer: Quartz Commercial |
$2,960.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,732.50
|
| Rate for Payer: The Alliance Commercial |
$2,277.08
|
| Rate for Payer: WEA Trust Commercial |
$2,504.79
|
| Rate for Payer: WPS Commercial |
$3,373.14
|
|
