|
CATHETER MALECOT 22FR 086022
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 22FR 086022
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 24FR 086024
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 24FR 086024
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 28 FRENCH
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 28 FRENCH
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 30 FRENCH
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 30 FRENCH
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 32fr
|
Facility
IP
|
$302.00
|
|
| Hospital Charge Code |
2963884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
CATHETER MALECOT 32fr
|
Facility
OP
|
$302.00
|
|
| Hospital Charge Code |
2963884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,208.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$84.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.20
|
| Rate for Payer: The Alliance Commercial |
$1,208.00
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
CATHETER MALECOT 34 FRENCH
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 34 FRENCH
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 36fr
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 36fr
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 40 FR
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALECOT 40 FR
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CATHETER MALE EXTERNAL LARGE 36MM 37104
|
Facility
OP
|
$44.00
|
|
| Hospital Charge Code |
2963330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
CATHETER MALE EXTERNAL LARGE 36MM 37104
|
Facility
IP
|
$44.00
|
|
| Hospital Charge Code |
2963330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
CATHETER MALE EXTERNAL SMALL 25MM 37101
|
Facility
OP
|
$44.00
|
|
| Hospital Charge Code |
2963329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
CATHETER MALE EXTERNAL SMALL 25MM 37101
|
Facility
IP
|
$44.00
|
|
| Hospital Charge Code |
2963329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
CATHETER MOTARJEME 5FR 5591-A3
|
Facility
OP
|
$330.00
|
|
| Hospital Charge Code |
2970952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Aetna Managed Medicare |
$92.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.67
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.50
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$198.00
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$214.50
|
| Rate for Payer: Quartz Medicare Advantage |
$198.00
|
| Rate for Payer: The Alliance Commercial |
$1,320.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
CATHETER MOTARJEME 5FR 5591-A3
|
Facility
IP
|
$330.00
|
|
| Hospital Charge Code |
2970952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$303.60 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$198.00
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
CATHETER MULTI LUMEN CV 16 CM CDC-42703-XP1A
|
Facility
IP
|
$954.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.46 |
| Max. Negotiated Rate |
$877.68 |
| Rate for Payer: Aetna Commercial |
$858.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.62
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$877.68
|
| Rate for Payer: Health EOS Commercial |
$849.06
|
| Rate for Payer: HFN Commercial |
$877.68
|
| Rate for Payer: Multiplan Commercial |
$763.20
|
| Rate for Payer: NAPHCARE Commercial |
$572.40
|
| Rate for Payer: Preferred Network Access Commercial |
$877.68
|
| Rate for Payer: Quartz Beloit One Network |
$467.46
|
| Rate for Payer: Quartz Commercial |
$572.40
|
| Rate for Payer: WEA Trust Commercial |
$524.70
|
| Rate for Payer: WPS Commercial |
$706.63
|
|
|
CATHETER MULTI LUMEN CV 16 CM CDC-42703-XP1A
|
Facility
OP
|
$954.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.12 |
| Max. Negotiated Rate |
$877.68 |
| Rate for Payer: Aetna Commercial |
$858.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.44
|
| Rate for Payer: Aetna Managed Medicare |
$267.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$620.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.62
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$877.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.86
|
| Rate for Payer: Health EOS Commercial |
$849.06
|
| Rate for Payer: HFN Commercial |
$877.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.50
|
| Rate for Payer: Multiplan Commercial |
$763.20
|
| Rate for Payer: NAPHCARE Commercial |
$572.40
|
| Rate for Payer: Preferred Network Access Commercial |
$877.68
|
| Rate for Payer: Quartz Beloit One Network |
$467.46
|
| Rate for Payer: Quartz Commercial |
$620.10
|
| Rate for Payer: Quartz Medicare Advantage |
$572.40
|
| Rate for Payer: WEA Trust Commercial |
$524.70
|
| Rate for Payer: WPS Commercial |
$706.63
|
|
|
CATHETER MULTI LUMEN CV 20 CM
|
Facility
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$1,295.36 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$844.80
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
