|
CATH CHEST TROCAR 28F
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: The Alliance Commercial |
$1,288.00
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 32F
|
Facility
|
IP
|
$322.00
|
|
| Hospital Charge Code |
2963071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 32F
|
Facility
|
OP
|
$322.00
|
|
| Hospital Charge Code |
2963071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: The Alliance Commercial |
$1,288.00
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHOLANGIOGRAM REDDICK SCOOP TIP e24051-50
|
Facility
|
IP
|
$1,907.00
|
|
| Hospital Charge Code |
3969315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.43 |
| Max. Negotiated Rate |
$1,754.44 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,144.20
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
CATH CHOLANGIOGRAM REDDICK SCOOP TIP e24051-50
|
Facility
|
OP
|
$1,907.00
|
|
| Hospital Charge Code |
3969315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.96 |
| Max. Negotiated Rate |
$7,628.00 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Aetna Managed Medicare |
$533.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,239.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$953.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.16
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,430.25
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,239.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.20
|
| Rate for Payer: The Alliance Commercial |
$7,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
CATH DIAL PERMHEMO FLOW STEP ANTEGRADE STRAIGHT 14.5F X 36CM DHFS 36
|
Facility
|
OP
|
$1,302.00
|
|
| Hospital Charge Code |
6207069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.56 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: Aetna Commercial |
$1,171.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,119.72
|
| Rate for Payer: Aetna Managed Medicare |
$364.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$624.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.06
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$1,197.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$728.60
|
| Rate for Payer: Health EOS Commercial |
$1,158.78
|
| Rate for Payer: HFN Commercial |
$1,197.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$976.50
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$781.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,197.84
|
| Rate for Payer: Quartz Beloit One Network |
$637.98
|
| Rate for Payer: Quartz Commercial |
$846.30
|
| Rate for Payer: Quartz Medicare Advantage |
$781.20
|
| Rate for Payer: The Alliance Commercial |
$5,208.00
|
| Rate for Payer: WEA Trust Commercial |
$716.10
|
| Rate for Payer: WPS Commercial |
$964.39
|
|
|
CATH DIAL PERMHEMO FLOW STEP ANTEGRADE STRAIGHT 14.5F X 36CM DHFS 36
|
Facility
|
IP
|
$1,302.00
|
|
| Hospital Charge Code |
6207069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$637.98 |
| Max. Negotiated Rate |
$1,197.84 |
| Rate for Payer: Aetna Commercial |
$1,171.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,119.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.06
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$1,197.84
|
| Rate for Payer: Health EOS Commercial |
$1,158.78
|
| Rate for Payer: HFN Commercial |
$1,197.84
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$781.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,197.84
|
| Rate for Payer: Quartz Beloit One Network |
$637.98
|
| Rate for Payer: Quartz Commercial |
$781.20
|
| Rate for Payer: WEA Trust Commercial |
$716.10
|
| Rate for Payer: WPS Commercial |
$964.39
|
|
|
CATH DIAL PERM HEMOSTAR LT STEP STRAIGHT 14.5F X 24CM 5833690
|
Facility
|
OP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,916.60 |
| Max. Negotiated Rate |
$27,380.00 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,916.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,449.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,422.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,285.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,830.46
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,133.75
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,449.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,107.00
|
| Rate for Payer: The Alliance Commercial |
$27,380.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATH DIAL PERM HEMOSTAR LT STEP STRAIGHT 14.5F X 24CM 5833690
|
Facility
|
IP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,354.05 |
| Max. Negotiated Rate |
$6,297.40 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,107.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATH DIAL PERM HEMOSTAR STEP STRAIGHT 14.5F X 28CM 5833730
|
Facility
|
OP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,916.60 |
| Max. Negotiated Rate |
$27,380.00 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,916.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,449.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,422.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,285.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,830.46
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,133.75
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,449.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,107.00
|
| Rate for Payer: The Alliance Commercial |
$27,380.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATH DIAL PERM HEMOSTAR STEP STRAIGHT 14.5F X 28CM 5833730
|
Facility
|
IP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,354.05 |
| Max. Negotiated Rate |
$6,297.40 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,107.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATHETER 100 LGTH ROYAL FLUSH QTY of 5
|
Facility
|
IP
|
$2,033.00
|
|
| Hospital Charge Code |
2972814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$996.17 |
| Max. Negotiated Rate |
$1,870.36 |
| Rate for Payer: Aetna Commercial |
$1,829.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.49
|
| Rate for Payer: Cash Price |
$609.90
|
| Rate for Payer: Cigna Commercial |
$1,870.36
|
| Rate for Payer: Health EOS Commercial |
$1,809.37
|
| Rate for Payer: HFN Commercial |
$1,870.36
|
| Rate for Payer: Multiplan Commercial |
$1,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.36
|
| Rate for Payer: Quartz Beloit One Network |
$996.17
|
| Rate for Payer: Quartz Commercial |
$1,219.80
|
| Rate for Payer: WEA Trust Commercial |
$1,118.15
|
| Rate for Payer: WPS Commercial |
$1,505.84
|
|
|
CATHETER 100 LGTH ROYAL FLUSH QTY of 5
|
Facility
|
OP
|
$2,033.00
|
|
| Hospital Charge Code |
2972814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.24 |
| Max. Negotiated Rate |
$8,132.00 |
| Rate for Payer: Aetna Commercial |
$1,829.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.38
|
| Rate for Payer: Aetna Managed Medicare |
$569.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,321.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.49
|
| Rate for Payer: Cash Price |
$609.90
|
| Rate for Payer: Cigna Commercial |
$1,870.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.67
|
| Rate for Payer: Health EOS Commercial |
$1,809.37
|
| Rate for Payer: HFN Commercial |
$1,870.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.75
|
| Rate for Payer: Multiplan Commercial |
$1,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.36
|
| Rate for Payer: Quartz Beloit One Network |
$996.17
|
| Rate for Payer: Quartz Commercial |
$1,321.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.80
|
| Rate for Payer: The Alliance Commercial |
$8,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,118.15
|
| Rate for Payer: WPS Commercial |
$1,505.84
|
|
|
CATHETER 10FR X 25CM NEPHROSTOMY M001271800
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2972395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$849.66 |
| Max. Negotiated Rate |
$1,595.28 |
| Rate for Payer: Aetna Commercial |
$1,560.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,491.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.02
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,595.28
|
| Rate for Payer: Health EOS Commercial |
$1,543.26
|
| Rate for Payer: HFN Commercial |
$1,595.28
|
| Rate for Payer: Multiplan Commercial |
$1,387.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,040.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,595.28
|
| Rate for Payer: Quartz Beloit One Network |
$849.66
|
| Rate for Payer: Quartz Commercial |
$1,040.40
|
| Rate for Payer: WEA Trust Commercial |
$953.70
|
| Rate for Payer: WPS Commercial |
$1,284.37
|
|
|
CATHETER 10FR X 25CM NEPHROSTOMY M001271800
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2972395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$6,936.00 |
| Rate for Payer: Aetna Commercial |
$1,560.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,491.24
|
| Rate for Payer: Aetna Managed Medicare |
$485.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,127.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$867.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$832.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.02
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,595.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$970.35
|
| Rate for Payer: Health EOS Commercial |
$1,543.26
|
| Rate for Payer: HFN Commercial |
$1,595.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,300.50
|
| Rate for Payer: Multiplan Commercial |
$1,387.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,040.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,595.28
|
| Rate for Payer: Quartz Beloit One Network |
$849.66
|
| Rate for Payer: Quartz Commercial |
$1,127.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,040.40
|
| Rate for Payer: The Alliance Commercial |
$6,936.00
|
| Rate for Payer: WEA Trust Commercial |
$953.70
|
| Rate for Payer: WPS Commercial |
$1,284.37
|
|
|
CATHETER 14FR COUDE TIEMANN URETHERAL STR LTX 010114
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
2974586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
CATHETER 14FR COUDE TIEMANN URETHERAL STR LTX 010114
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
2974586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$63.00
|
| Rate for Payer: The Alliance Commercial |
$420.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
CATHETER 14FR RED RUBBER URETHRAL 056114
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS A4352
|
| Hospital Charge Code |
3065493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$25.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$55.20
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
CATHETER 14FR RED RUBBER URETHRAL 056114
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS A4352
|
| Hospital Charge Code |
3065493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
CATHETER 16FR 30CC 3-WAY 0167L16
|
Facility
|
IP
|
$271.00
|
|
| Hospital Charge Code |
2963213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
CATHETER 16FR 30CC 3-WAY 0167L16
|
Facility
|
OP
|
$271.00
|
|
| Hospital Charge Code |
2963213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.88 |
| Max. Negotiated Rate |
$1,084.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$75.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.65
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.25
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$162.60
|
| Rate for Payer: The Alliance Commercial |
$1,084.00
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
CATHETER 16FR FOLEY 5CC 0165L16
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
2974583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
CATHETER 16FR FOLEY 5CC 0165L16
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
2974583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$29.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$63.60
|
| Rate for Payer: The Alliance Commercial |
$424.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
CATHETER 16FR FOLEY 5CC 2-WAY COUDE 0168L16
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
2974761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
CATHETER 16FR FOLEY 5CC 2-WAY COUDE 0168L16
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
2974761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
