|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
|
IP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,542.59 |
| Max. Negotiated Rate |
$14,161.60 |
| Rate for Payer: Aetna Commercial |
$13,853.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,238.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,158.31
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$14,161.60
|
| Rate for Payer: Health EOS Commercial |
$13,699.81
|
| Rate for Payer: HFN Commercial |
$14,161.60
|
| Rate for Payer: Multiplan Commercial |
$12,314.43
|
| Rate for Payer: Preferred Network Access Commercial |
$14,161.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,542.59
|
| Rate for Payer: Quartz Commercial |
$9,235.82
|
| Rate for Payer: WEA Trust Commercial |
$8,466.17
|
| Rate for Payer: WPS Commercial |
$11,401.21
|
|
|
CATHETER JETSTREAM ATHRECTOMY
|
Facility
|
OP
|
$14,801.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,310.05 |
| Max. Negotiated Rate |
$14,161.60 |
| Rate for Payer: Aetna Commercial |
$13,853.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,238.01
|
| Rate for Payer: Aetna Managed Medicare |
$4,310.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,005.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,696.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,388.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,158.31
|
| Rate for Payer: Cash Price |
$4,440.30
|
| Rate for Payer: Cigna Commercial |
$14,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,614.18
|
| Rate for Payer: Health EOS Commercial |
$13,699.81
|
| Rate for Payer: HFN Commercial |
$14,161.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,544.78
|
| Rate for Payer: Multiplan Commercial |
$12,314.43
|
| Rate for Payer: NAPHCARE Commercial |
$9,235.82
|
| Rate for Payer: Preferred Network Access Commercial |
$14,161.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,542.59
|
| Rate for Payer: Quartz Commercial |
$10,005.48
|
| Rate for Payer: Quartz Medicare Advantage |
$9,235.82
|
| Rate for Payer: The Alliance Commercial |
$7,696.52
|
| Rate for Payer: WEA Trust Commercial |
$8,466.17
|
| Rate for Payer: WPS Commercial |
$11,401.21
|
|
|
CATHETER JETSTREAM G3SF 1.6
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,571.65 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$12,944.88
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM G3SF 1.6
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,040.94 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Aetna Managed Medicare |
$6,040.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,023.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,787.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,355.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,073.59
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,181.10
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,944.88
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$14,023.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12,944.88
|
| Rate for Payer: The Alliance Commercial |
$10,787.40
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM G3SF 1.85
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,040.94 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Aetna Managed Medicare |
$6,040.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,023.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,787.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,355.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,073.59
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,181.10
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,944.88
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$14,023.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12,944.88
|
| Rate for Payer: The Alliance Commercial |
$10,787.40
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM G3SF 1.85
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,571.65 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$12,944.88
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM L
|
Facility
|
IP
|
$20,745.00
|
|
| Hospital Charge Code |
2973936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10,571.65 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$12,944.88
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JETSTREAM L
|
Facility
|
OP
|
$20,745.00
|
|
| Hospital Charge Code |
2973936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,040.94 |
| Max. Negotiated Rate |
$19,848.82 |
| Rate for Payer: Aetna Commercial |
$19,417.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,554.33
|
| Rate for Payer: Aetna Managed Medicare |
$6,040.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,023.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,787.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,355.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,434.64
|
| Rate for Payer: Cash Price |
$6,223.50
|
| Rate for Payer: Cigna Commercial |
$19,848.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,073.59
|
| Rate for Payer: Health EOS Commercial |
$19,201.57
|
| Rate for Payer: HFN Commercial |
$19,848.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,181.10
|
| Rate for Payer: Multiplan Commercial |
$17,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,944.88
|
| Rate for Payer: Preferred Network Access Commercial |
$19,848.82
|
| Rate for Payer: Quartz Beloit One Network |
$10,571.65
|
| Rate for Payer: Quartz Commercial |
$14,023.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12,944.88
|
| Rate for Payer: The Alliance Commercial |
$10,787.40
|
| Rate for Payer: WEA Trust Commercial |
$11,866.14
|
| Rate for Payer: WPS Commercial |
$15,979.87
|
|
|
CATHETER JL4 T 6FR 534620T
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2971393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER JL4 T 6FR 534620T
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2971393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
CATHETER KIT FEMALE 8FR 0035720
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2963307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CATHETER KIT FEMALE 8FR 0035720
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2963307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CATHETER KUMAR CHOLANGIOGRAPHY CC-019
|
Facility
|
IP
|
$679.00
|
|
| Hospital Charge Code |
5178933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.02 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$635.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.26
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$649.67
|
| Rate for Payer: Health EOS Commercial |
$628.48
|
| Rate for Payer: HFN Commercial |
$649.67
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: Preferred Network Access Commercial |
$649.67
|
| Rate for Payer: Quartz Beloit One Network |
$346.02
|
| Rate for Payer: Quartz Commercial |
$423.70
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$523.03
|
|
|
CATHETER KUMAR CHOLANGIOGRAPHY CC-019
|
Facility
|
OP
|
$679.00
|
|
| Hospital Charge Code |
5178933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.72 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$635.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$459.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.26
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$649.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.18
|
| Rate for Payer: Health EOS Commercial |
$628.48
|
| Rate for Payer: HFN Commercial |
$649.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.62
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: NAPHCARE Commercial |
$423.70
|
| Rate for Payer: Preferred Network Access Commercial |
$649.67
|
| Rate for Payer: Quartz Beloit One Network |
$346.02
|
| Rate for Payer: Quartz Commercial |
$459.00
|
| Rate for Payer: Quartz Medicare Advantage |
$423.70
|
| Rate for Payer: The Alliance Commercial |
$353.08
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$523.03
|
|
|
CATHETER LATEX 24fr 0165L24
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
2974584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$29.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.56
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$63.65
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$63.65
|
| Rate for Payer: The Alliance Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
CATHETER LATEX 24fr 0165L24
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
2974584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
CATHETER LEFT HEART VENT 16FR PEAK LVV-016S
|
Facility
|
IP
|
$364.00
|
|
| Hospital Charge Code |
5831769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.49 |
| Max. Negotiated Rate |
$348.28 |
| Rate for Payer: Aetna Commercial |
$340.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.64
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$348.28
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$348.28
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: Preferred Network Access Commercial |
$348.28
|
| Rate for Payer: Quartz Beloit One Network |
$185.49
|
| Rate for Payer: Quartz Commercial |
$227.14
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$280.39
|
|
|
CATHETER LEFT HEART VENT 16FR PEAK LVV-016S
|
Facility
|
OP
|
$364.00
|
|
| Hospital Charge Code |
5831769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$348.28 |
| Rate for Payer: Aetna Commercial |
$340.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Aetna Managed Medicare |
$106.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.64
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$348.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$348.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: NAPHCARE Commercial |
$227.14
|
| Rate for Payer: Preferred Network Access Commercial |
$348.28
|
| Rate for Payer: Quartz Beloit One Network |
$185.49
|
| Rate for Payer: Quartz Commercial |
$246.06
|
| Rate for Payer: Quartz Medicare Advantage |
$227.14
|
| Rate for Payer: The Alliance Commercial |
$189.28
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$280.39
|
|
|
CATHETER LEFT HEART VENT 18FR PEAK LVV-018S
|
Facility
|
OP
|
$379.00
|
|
| Hospital Charge Code |
5831768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Aetna Managed Medicare |
$110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$197.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.58
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.62
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: NAPHCARE Commercial |
$236.50
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: Quartz Medicare Advantage |
$236.50
|
| Rate for Payer: The Alliance Commercial |
$197.08
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
CATHETER LEFT HEART VENT 18FR PEAK LVV-018S
|
Facility
|
IP
|
$379.00
|
|
| Hospital Charge Code |
5831768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.14 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$236.50
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
CATHETER LEFT HEART VENT DLP 18FR (6.0MM) MALLEABLE NON-VENTED 12118
|
Facility
|
IP
|
$470.00
|
|
| Hospital Charge Code |
4858648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.51 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
CATHETER LEFT HEART VENT DLP 18FR (6.0MM) MALLEABLE NON-VENTED 12118
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
4858648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$136.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.54
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$293.28
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$317.72
|
| Rate for Payer: Quartz Medicare Advantage |
$293.28
|
| Rate for Payer: The Alliance Commercial |
$244.40
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
CATHETER MAC-LOC MULTIPURPOSE DRAINAGE 10.2FR X 45CM ULTRATHANE G09766
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.58 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$915.41
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
CATHETER MAC-LOC MULTIPURPOSE DRAINAGE 10.2FR X 45CM ULTRATHANE G09766
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.19 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Aetna Managed Medicare |
$427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.79
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,144.26
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: NAPHCARE Commercial |
$915.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$991.69
|
| Rate for Payer: Quartz Medicare Advantage |
$915.41
|
| Rate for Payer: The Alliance Commercial |
$762.84
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
CATHETER MALECOT 14 FRENCH
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2963721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$152.36
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
