|
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
|
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 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 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
|
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 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 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
|
|
|
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 |
$2,231.54 |
| 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 2.15mm 23631-015
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.16 |
| 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 2.15mm 23631-015
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609500
|
|
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 2.25mm 23631-006
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,231.54 |
| 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 2.25mm 23631-006
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.16 |
| 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 2.38mm 23631-016
|
Facility
|
IP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609502
|
|
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 2.38mm 23631-016
|
Facility
|
OP
|
$4,379.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
3609502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.16 |
| 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 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 |
$41.56 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$57.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$101.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.07
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$132.50
|
| Rate for Payer: Quartz Medicare Advantage |
$122.30
|
| Rate for Payer: The Alliance Commercial |
$41.56
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
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 |
$99.88 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$122.30
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
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 |
$304.60 |
| Max. Negotiated Rate |
$1,000.81 |
| Rate for Payer: Aetna Commercial |
$979.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.54
|
| Rate for Payer: Aetna Managed Medicare |
$304.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$707.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$543.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$522.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$576.56
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$1,000.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$608.77
|
| Rate for Payer: Health EOS Commercial |
$968.18
|
| Rate for Payer: HFN Commercial |
$1,000.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$815.88
|
| Rate for Payer: Multiplan Commercial |
$870.27
|
| Rate for Payer: NAPHCARE Commercial |
$652.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,000.81
|
| Rate for Payer: Quartz Beloit One Network |
$533.04
|
| Rate for Payer: Quartz Commercial |
$707.10
|
| Rate for Payer: Quartz Medicare Advantage |
$652.70
|
| Rate for Payer: The Alliance Commercial |
$543.92
|
| Rate for Payer: WEA Trust Commercial |
$598.31
|
| Rate for Payer: WPS Commercial |
$805.73
|
|
|
CATHETER SHOLKOFF BALLOON 6.8F #J-SBH-683000***DISC 4/17
|
Facility
|
IP
|
$1,046.00
|
|
| Hospital Charge Code |
2971965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.04 |
| Max. Negotiated Rate |
$1,000.81 |
| Rate for Payer: Aetna Commercial |
$979.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$576.56
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$1,000.81
|
| Rate for Payer: Health EOS Commercial |
$968.18
|
| Rate for Payer: HFN Commercial |
$1,000.81
|
| Rate for Payer: Multiplan Commercial |
$870.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,000.81
|
| Rate for Payer: Quartz Beloit One Network |
$533.04
|
| Rate for Payer: Quartz Commercial |
$652.70
|
| Rate for Payer: WEA Trust Commercial |
$598.31
|
| Rate for Payer: WPS Commercial |
$805.73
|
|
