|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$820.44
|
| 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 |
$3,816.00 |
| 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: The Alliance Commercial |
$3,816.00
|
| Rate for Payer: WEA Trust Commercial |
$524.70
|
| Rate for Payer: WPS Commercial |
$706.63
|
|
|
CATHETER MULTI LUMEN CV 20 CM
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$5,632.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Aetna Managed Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.84
|
| 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: Dean Health DHI/DHP/ASO |
$787.92
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.00
|
| 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 |
$915.20
|
| Rate for Payer: Quartz Medicare Advantage |
$844.80
|
| Rate for Payer: The Alliance Commercial |
$5,632.00
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| 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
|
|
|
CATHETER MULTIPURPOSE DRAINAGE 12FR X 45CM G09767
|
Facility
|
OP
|
$2,488.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$696.64 |
| Max. Negotiated Rate |
$9,952.00 |
| Rate for Payer: Aetna Commercial |
$2,239.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.68
|
| Rate for Payer: Aetna Managed Medicare |
$696.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,617.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,244.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,194.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.64
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,288.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,392.28
|
| Rate for Payer: Health EOS Commercial |
$2,214.32
|
| Rate for Payer: HFN Commercial |
$2,288.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,866.00
|
| Rate for Payer: Multiplan Commercial |
$1,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.12
|
| Rate for Payer: Quartz Commercial |
$1,617.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,492.80
|
| Rate for Payer: The Alliance Commercial |
$9,952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
|
CATHETER MULTIPURPOSE DRAINAGE 12FR X 45CM G09767
|
Facility
|
IP
|
$2,488.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$2,288.96 |
| Rate for Payer: Aetna Commercial |
$2,239.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.64
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,288.96
|
| Rate for Payer: Health EOS Commercial |
$2,214.32
|
| Rate for Payer: HFN Commercial |
$2,288.96
|
| Rate for Payer: Multiplan Commercial |
$1,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.12
|
| Rate for Payer: Quartz Commercial |
$1,492.80
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
|
CATHETER OPEN END 5FR G14274
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2965533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$53.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.44
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$115.20
|
| Rate for Payer: The Alliance Commercial |
$768.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
CATHETER OPEN END 5FR G14274
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2965533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
CATHETER OPEN END 5FR URETERAL M0064002010
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER OPEN END 5FR URETERAL M0064002010
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: The Alliance Commercial |
$1,032.00
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER OPEN END 5FR X 70CM FLEXI-TIP URETERAL G14521
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$80.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$171.60
|
| Rate for Payer: The Alliance Commercial |
$1,144.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
CATHETER OPEN END 5FR X 70CM FLEXI-TIP URETERAL G14521
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
CATHETER OPEN END 6FR G15942
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
2965856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
CATHETER OPEN END 6FR G15942
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
2965856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
CATHETER OPTI-Q SvO2 52509-14
|
Facility
|
IP
|
$3,016.00
|
|
| Hospital Charge Code |
2963033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,477.84 |
| Max. Negotiated Rate |
$2,774.72 |
| Rate for Payer: Aetna Commercial |
$2,714.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,593.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,598.48
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cigna Commercial |
$2,774.72
|
| Rate for Payer: Health EOS Commercial |
$2,684.24
|
| Rate for Payer: HFN Commercial |
$2,774.72
|
| Rate for Payer: Multiplan Commercial |
$2,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,477.84
|
| Rate for Payer: Quartz Commercial |
$1,809.60
|
| Rate for Payer: WEA Trust Commercial |
$1,658.80
|
| Rate for Payer: WPS Commercial |
$2,233.95
|
|
|
CATHETER OPTI-Q SvO2 52509-14
|
Facility
|
OP
|
$3,016.00
|
|
| Hospital Charge Code |
2963033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.48 |
| Max. Negotiated Rate |
$12,064.00 |
| Rate for Payer: Aetna Commercial |
$2,714.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,593.76
|
| Rate for Payer: Aetna Managed Medicare |
$844.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,960.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,447.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,598.48
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cigna Commercial |
$2,774.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,687.75
|
| Rate for Payer: Health EOS Commercial |
$2,684.24
|
| Rate for Payer: HFN Commercial |
$2,774.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.00
|
| Rate for Payer: Multiplan Commercial |
$2,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,477.84
|
| Rate for Payer: Quartz Commercial |
$1,960.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,809.60
|
| Rate for Payer: The Alliance Commercial |
$12,064.00
|
| Rate for Payer: WEA Trust Commercial |
$1,658.80
|
| Rate for Payer: WPS Commercial |
$2,233.95
|
|
|
CATHETER PERIFIX OPEN TIP EC200 333520
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
5520794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$752.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Aetna Managed Medicare |
$52.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.20
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| Rate for Payer: Quartz Medicare Advantage |
$112.80
|
| Rate for Payer: The Alliance Commercial |
$752.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
CATHETER PERIFIX OPEN TIP EC200 333520
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
5520794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$112.80
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
CATHETER PHIL FOLLOWER 22F
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2963085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
CATHETER PHIL FOLLOWER 22F
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2963085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
CATHETER PICC PWRD DOUBLE 5 FR. 3275355F
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2962940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$5,820.00 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Aetna Managed Medicare |
$407.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.22
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.25
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$945.75
|
| Rate for Payer: Quartz Medicare Advantage |
$873.00
|
| Rate for Payer: The Alliance Commercial |
$5,820.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
CATHETER PICC PWRD DOUBLE 5 FR. 3275355F
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2962940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.95 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$873.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
