|
CATHETER BERN IMAGER II 5FR X 40CM M0064005030
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER BERN IMAGER II 5FR X 40CM M0064005030
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER BERN IMAGER II 5FR X 65CM M0064003030
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER BERN IMAGER II 5FR X 65CM M0064003030
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER CABLE
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
CATHETER CABLE
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.62
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$1,189.76
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
CATHETER CAP #418027
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
2970155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
CATHETER CAP #418027
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
2970155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
CATHETER CLOSUREFAST 3CM CF7-3-60
|
Facility
|
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,271.36 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,271.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,272.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,893.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,539.60
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,084.00
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,867.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$5,272.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,867.20
|
| Rate for Payer: The Alliance Commercial |
$4,056.00
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 3CM CF7-3-60
|
Facility
|
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,974.88 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$4,867.20
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 7FR 100CM CF7-7-100
|
Facility
|
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,974.88 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$4,867.20
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 7FR 100CM CF7-7-100
|
Facility
|
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,271.36 |
| Max. Negotiated Rate |
$7,463.04 |
| Rate for Payer: Aetna Commercial |
$7,300.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,976.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,271.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,272.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,893.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,299.36
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Cigna Commercial |
$7,463.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,539.60
|
| Rate for Payer: Health EOS Commercial |
$7,219.68
|
| Rate for Payer: HFN Commercial |
$7,463.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,084.00
|
| Rate for Payer: Multiplan Commercial |
$6,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,867.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,463.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,974.88
|
| Rate for Payer: Quartz Commercial |
$5,272.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,867.20
|
| Rate for Payer: The Alliance Commercial |
$4,056.00
|
| Rate for Payer: WEA Trust Commercial |
$4,461.60
|
| Rate for Payer: WPS Commercial |
$6,008.34
|
|
|
CATHETER CLOSUREFAST 7FR 60CM CF7-7-60
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,359.01 |
| Max. Negotiated Rate |
$7,751.04 |
| Rate for Payer: Aetna Commercial |
$7,582.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,245.53
|
| Rate for Payer: Aetna Managed Medicare |
$2,359.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,476.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,212.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,044.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,465.27
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,751.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,714.78
|
| Rate for Payer: Health EOS Commercial |
$7,498.29
|
| Rate for Payer: HFN Commercial |
$7,751.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,318.78
|
| Rate for Payer: Multiplan Commercial |
$6,740.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,055.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,751.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.27
|
| Rate for Payer: Quartz Commercial |
$5,476.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,055.02
|
| Rate for Payer: The Alliance Commercial |
$4,212.52
|
| Rate for Payer: WEA Trust Commercial |
$4,633.77
|
| Rate for Payer: WPS Commercial |
$6,240.20
|
|
|
CATHETER CLOSUREFAST 7FR 60CM CF7-7-60
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
4069306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,128.27 |
| Max. Negotiated Rate |
$7,751.04 |
| Rate for Payer: Aetna Commercial |
$7,582.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,245.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,465.27
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,751.04
|
| Rate for Payer: Health EOS Commercial |
$7,498.29
|
| Rate for Payer: HFN Commercial |
$7,751.04
|
| Rate for Payer: Multiplan Commercial |
$6,740.03
|
| Rate for Payer: Preferred Network Access Commercial |
$7,751.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.27
|
| Rate for Payer: Quartz Commercial |
$5,055.02
|
| Rate for Payer: WEA Trust Commercial |
$4,633.77
|
| Rate for Payer: WPS Commercial |
$6,240.20
|
|
|
CATHETER CONE TIP 10FR URETERAL G14665
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP 10FR URETERAL G14665
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP12FR URETERAL 024607
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP12FR URETERAL 024607
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2964974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
CATHETER CONE TIP 5FR URETERAL M0064002110
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 5FR URETERAL M0064002110
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 6FR X 70CM 10FR TIP URETERAL M0064002121
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4519310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 6FR X 70CM 10FR TIP URETERAL M0064002121
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4519310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 7FR X 70CM URETERAL M0064002130
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 7FR X 70CM URETERAL M0064002130
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CATHETER CONE TIP 8FR URETERAL G14663
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2963868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$61.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$132.29
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
