|
CATH CHEST TROCAR 32F
|
Facility
|
OP
|
$322.00
|
|
| Hospital Charge Code |
2963071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$93.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.16
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$200.93
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| Rate for Payer: Quartz Medicare Advantage |
$200.93
|
| Rate for Payer: The Alliance Commercial |
$167.44
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
CATH CHEST TROCAR 32F
|
Facility
|
IP
|
$322.00
|
|
| Hospital Charge Code |
2963071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
CATH CHOLANGIOGRAM REDDICK SCOOP TIP e24051-50
|
Facility
|
OP
|
$1,907.00
|
|
| Hospital Charge Code |
3969315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.32 |
| Max. Negotiated Rate |
$1,824.62 |
| Rate for Payer: Aetna Commercial |
$1,784.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.62
|
| Rate for Payer: Aetna Managed Medicare |
$555.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,289.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.14
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,824.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.87
|
| Rate for Payer: Health EOS Commercial |
$1,765.12
|
| Rate for Payer: HFN Commercial |
$1,824.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.46
|
| Rate for Payer: Multiplan Commercial |
$1,586.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.62
|
| Rate for Payer: Quartz Beloit One Network |
$971.81
|
| Rate for Payer: Quartz Commercial |
$1,289.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.97
|
| Rate for Payer: The Alliance Commercial |
$991.64
|
| Rate for Payer: WEA Trust Commercial |
$1,090.80
|
| Rate for Payer: WPS Commercial |
$1,468.96
|
|
|
CATH CHOLANGIOGRAM REDDICK SCOOP TIP e24051-50
|
Facility
|
IP
|
$1,907.00
|
|
| Hospital Charge Code |
3969315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.81 |
| Max. Negotiated Rate |
$1,824.62 |
| Rate for Payer: Aetna Commercial |
$1,784.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.14
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,824.62
|
| Rate for Payer: Health EOS Commercial |
$1,765.12
|
| Rate for Payer: HFN Commercial |
$1,824.62
|
| Rate for Payer: Multiplan Commercial |
$1,586.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.62
|
| Rate for Payer: Quartz Beloit One Network |
$971.81
|
| Rate for Payer: Quartz Commercial |
$1,189.97
|
| Rate for Payer: WEA Trust Commercial |
$1,090.80
|
| Rate for Payer: WPS Commercial |
$1,468.96
|
|
|
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 |
$379.14 |
| Max. Negotiated Rate |
$1,245.75 |
| Rate for Payer: Aetna Commercial |
$1,218.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,164.51
|
| Rate for Payer: Aetna Managed Medicare |
$379.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.66
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$1,245.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.76
|
| Rate for Payer: Health EOS Commercial |
$1,205.13
|
| Rate for Payer: HFN Commercial |
$1,245.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,015.56
|
| Rate for Payer: Multiplan Commercial |
$1,083.26
|
| Rate for Payer: NAPHCARE Commercial |
$812.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,245.75
|
| Rate for Payer: Quartz Beloit One Network |
$663.50
|
| Rate for Payer: Quartz Commercial |
$880.15
|
| Rate for Payer: Quartz Medicare Advantage |
$812.45
|
| Rate for Payer: The Alliance Commercial |
$677.04
|
| Rate for Payer: WEA Trust Commercial |
$744.74
|
| Rate for Payer: WPS Commercial |
$1,002.93
|
|
|
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 |
$663.50 |
| Max. Negotiated Rate |
$1,245.75 |
| Rate for Payer: Aetna Commercial |
$1,218.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,164.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.66
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$1,245.75
|
| Rate for Payer: Health EOS Commercial |
$1,205.13
|
| Rate for Payer: HFN Commercial |
$1,245.75
|
| Rate for Payer: Multiplan Commercial |
$1,083.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,245.75
|
| Rate for Payer: Quartz Beloit One Network |
$663.50
|
| Rate for Payer: Quartz Commercial |
$812.45
|
| Rate for Payer: WEA Trust Commercial |
$744.74
|
| Rate for Payer: WPS Commercial |
$1,002.93
|
|
|
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 |
$3,488.21 |
| Max. Negotiated Rate |
$6,549.30 |
| Rate for Payer: Aetna Commercial |
$6,406.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,122.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,772.96
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,549.30
|
| Rate for Payer: Health EOS Commercial |
$6,335.73
|
| Rate for Payer: HFN Commercial |
$6,549.30
|
| Rate for Payer: Multiplan Commercial |
$5,695.04
|
| Rate for Payer: Preferred Network Access Commercial |
$6,549.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,488.21
|
| Rate for Payer: Quartz Commercial |
$4,271.28
|
| Rate for Payer: WEA Trust Commercial |
$3,915.34
|
| Rate for Payer: WPS Commercial |
$5,272.70
|
|
|
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 |
$1,993.26 |
| Max. Negotiated Rate |
$6,549.30 |
| Rate for Payer: Aetna Commercial |
$6,406.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,122.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,993.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,627.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,559.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,417.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,772.96
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,549.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,983.79
|
| Rate for Payer: Health EOS Commercial |
$6,335.73
|
| Rate for Payer: HFN Commercial |
$6,549.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,339.10
|
| Rate for Payer: Multiplan Commercial |
$5,695.04
|
| Rate for Payer: NAPHCARE Commercial |
$4,271.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,549.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,488.21
|
| Rate for Payer: Quartz Commercial |
$4,627.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,271.28
|
| Rate for Payer: The Alliance Commercial |
$3,559.40
|
| Rate for Payer: WEA Trust Commercial |
$3,915.34
|
| Rate for Payer: WPS Commercial |
$5,272.70
|
|
|
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 |
$3,488.21 |
| Max. Negotiated Rate |
$6,549.30 |
| Rate for Payer: Aetna Commercial |
$6,406.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,122.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,772.96
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,549.30
|
| Rate for Payer: Health EOS Commercial |
$6,335.73
|
| Rate for Payer: HFN Commercial |
$6,549.30
|
| Rate for Payer: Multiplan Commercial |
$5,695.04
|
| Rate for Payer: Preferred Network Access Commercial |
$6,549.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,488.21
|
| Rate for Payer: Quartz Commercial |
$4,271.28
|
| Rate for Payer: WEA Trust Commercial |
$3,915.34
|
| Rate for Payer: WPS Commercial |
$5,272.70
|
|
|
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 |
$1,993.26 |
| Max. Negotiated Rate |
$6,549.30 |
| Rate for Payer: Aetna Commercial |
$6,406.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,122.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,993.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,627.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,559.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,417.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,772.96
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,549.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,983.79
|
| Rate for Payer: Health EOS Commercial |
$6,335.73
|
| Rate for Payer: HFN Commercial |
$6,549.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,339.10
|
| Rate for Payer: Multiplan Commercial |
$5,695.04
|
| Rate for Payer: NAPHCARE Commercial |
$4,271.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,549.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,488.21
|
| Rate for Payer: Quartz Commercial |
$4,627.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,271.28
|
| Rate for Payer: The Alliance Commercial |
$3,559.40
|
| Rate for Payer: WEA Trust Commercial |
$3,915.34
|
| Rate for Payer: WPS Commercial |
$5,272.70
|
|
|
CATHETER 100 LGTH ROYAL FLUSH QTY of 5
|
Facility
|
IP
|
$2,033.00
|
|
| Hospital Charge Code |
2972814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.02 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna Commercial |
$1,902.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.59
|
| Rate for Payer: Cash Price |
$609.90
|
| Rate for Payer: Cigna Commercial |
$1,945.17
|
| Rate for Payer: Health EOS Commercial |
$1,881.74
|
| Rate for Payer: HFN Commercial |
$1,945.17
|
| Rate for Payer: Multiplan Commercial |
$1,691.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.02
|
| Rate for Payer: Quartz Commercial |
$1,268.59
|
| Rate for Payer: WEA Trust Commercial |
$1,162.88
|
| Rate for Payer: WPS Commercial |
$1,566.02
|
|
|
CATHETER 100 LGTH ROYAL FLUSH QTY of 5
|
Facility
|
OP
|
$2,033.00
|
|
| Hospital Charge Code |
2972814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.01 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna Commercial |
$1,902.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.32
|
| Rate for Payer: Aetna Managed Medicare |
$592.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,014.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.59
|
| Rate for Payer: Cash Price |
$609.90
|
| Rate for Payer: Cigna Commercial |
$1,945.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.21
|
| Rate for Payer: Health EOS Commercial |
$1,881.74
|
| Rate for Payer: HFN Commercial |
$1,945.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,585.74
|
| Rate for Payer: Multiplan Commercial |
$1,691.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,268.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.02
|
| Rate for Payer: Quartz Commercial |
$1,374.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,268.59
|
| Rate for Payer: The Alliance Commercial |
$1,057.16
|
| Rate for Payer: WEA Trust Commercial |
$1,162.88
|
| Rate for Payer: WPS Commercial |
$1,566.02
|
|
|
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 |
$504.94 |
| Max. Negotiated Rate |
$1,659.09 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,550.89
|
| Rate for Payer: Aetna Managed Medicare |
$504.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,172.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$901.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$865.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.78
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,659.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,009.19
|
| Rate for Payer: Health EOS Commercial |
$1,604.99
|
| Rate for Payer: HFN Commercial |
$1,659.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,352.52
|
| Rate for Payer: Multiplan Commercial |
$1,442.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,082.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,659.09
|
| Rate for Payer: Quartz Beloit One Network |
$883.65
|
| Rate for Payer: Quartz Commercial |
$1,172.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,082.02
|
| Rate for Payer: The Alliance Commercial |
$901.68
|
| Rate for Payer: WEA Trust Commercial |
$991.85
|
| Rate for Payer: WPS Commercial |
$1,335.70
|
|
|
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 |
$883.65 |
| Max. Negotiated Rate |
$1,659.09 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,550.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.78
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,659.09
|
| Rate for Payer: Health EOS Commercial |
$1,604.99
|
| Rate for Payer: HFN Commercial |
$1,659.09
|
| Rate for Payer: Multiplan Commercial |
$1,442.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,659.09
|
| Rate for Payer: Quartz Beloit One Network |
$883.65
|
| Rate for Payer: Quartz Commercial |
$1,082.02
|
| Rate for Payer: WEA Trust Commercial |
$991.85
|
| Rate for Payer: WPS Commercial |
$1,335.70
|
|
|
CATHETER 14FR COUDE TIEMANN URETHERAL STR LTX 010114
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
2974586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$30.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$65.52
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$65.52
|
| Rate for Payer: The Alliance Commercial |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
CATHETER 14FR COUDE TIEMANN URETHERAL STR LTX 010114
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
2974586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
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 |
$26.79 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$57.41
|
| Rate for Payer: The Alliance Commercial |
$32.36
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
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 |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
CATHETER 16FR 30CC 3-WAY 0167L16
|
Facility
|
OP
|
$271.00
|
|
| Hospital Charge Code |
2963213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.38
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$169.10
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$169.10
|
| Rate for Payer: The Alliance Commercial |
$140.92
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
CATHETER 16FR 30CC 3-WAY 0167L16
|
Facility
|
IP
|
$271.00
|
|
| Hospital Charge Code |
2963213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
CATHETER 16FR FOLEY 5CC 0165L16
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
2974583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
CATHETER 16FR FOLEY 5CC 0165L16
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
2974583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
CATHETER 16FR FOLEY 5CC 2-WAY COUDE 0168L16
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
2974761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
CATHETER 16FR FOLEY 5CC 2-WAY COUDE 0168L16
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
2974761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
CATHETER 18FR FOLEY 10CC 2-WAY COUDE RUSCH 318118
|
Facility
|
IP
|
$196.00
|
|
| Hospital Charge Code |
2963367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: HFN Commercial |
$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: 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
|
|
