|
CATHETER UMBILICAL ARTERY 5FR 8888160341
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
2963031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$77.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.89
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$165.00
|
| Rate for Payer: The Alliance Commercial |
$1,100.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
CATHETER URETERAL 6FR X 70CM OPEN END M0064002020
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520014
|
|
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 URETERAL 6FR X 70CM OPEN END M0064002020
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520014
|
|
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 URETERAL ADAPTER 140000
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2963898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
CATHETER URETERAL ADAPTER 140000
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2963898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.31
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
CATHETER URETERAL DUAL LUMEN 10FR X 54CM M0064051000
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.64 |
| Max. Negotiated Rate |
$1,137.12 |
| Rate for Payer: Aetna Commercial |
$1,112.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.08
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,137.12
|
| Rate for Payer: Health EOS Commercial |
$1,100.04
|
| Rate for Payer: HFN Commercial |
$1,137.12
|
| Rate for Payer: Multiplan Commercial |
$988.80
|
| Rate for Payer: NAPHCARE Commercial |
$741.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,137.12
|
| Rate for Payer: Quartz Beloit One Network |
$605.64
|
| Rate for Payer: Quartz Commercial |
$741.60
|
| Rate for Payer: WEA Trust Commercial |
$679.80
|
| Rate for Payer: WPS Commercial |
$915.51
|
|
|
CATHETER URETERAL DUAL LUMEN 10FR X 54CM M0064051000
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
5306817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.08 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$1,112.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.96
|
| Rate for Payer: Aetna Managed Medicare |
$346.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.08
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,137.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.67
|
| Rate for Payer: Health EOS Commercial |
$1,100.04
|
| Rate for Payer: HFN Commercial |
$1,137.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.00
|
| Rate for Payer: Multiplan Commercial |
$988.80
|
| Rate for Payer: NAPHCARE Commercial |
$741.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,137.12
|
| Rate for Payer: Quartz Beloit One Network |
$605.64
|
| Rate for Payer: Quartz Commercial |
$803.40
|
| Rate for Payer: Quartz Medicare Advantage |
$741.60
|
| Rate for Payer: The Alliance Commercial |
$4,944.00
|
| Rate for Payer: WEA Trust Commercial |
$679.80
|
| Rate for Payer: WPS Commercial |
$915.51
|
|
|
CATHETER URETERAL DUAL LUMEN 405-100
|
Facility
|
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2964806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$6,460.00 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.75
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.25
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$1,049.75
|
| Rate for Payer: Quartz Medicare Advantage |
$969.00
|
| Rate for Payer: The Alliance Commercial |
$6,460.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
CATHETER URETERAL DUAL LUMEN 405-100
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2964806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$969.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
CATHETER URETHERAL 12F 400612
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
2963384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHERAL 12F 400612
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
2963384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHERAL 8 FR 400608
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
2963445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
CATHETER URETHERAL 8 FR 400608
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
2963445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
CATHETER URETHRAL 14FR 400614
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHRAL 14FR 400614
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHRAL 16FR 400616
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
2962821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER URETHRAL 16FR 400616
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
2962821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
CATHETER VANSCHIE5
|
Facility
|
IP
|
$556.00
|
|
| Hospital Charge Code |
2971412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CATHETER VANSCHIE5
|
Facility
|
OP
|
$556.00
|
|
| Hospital Charge Code |
2971412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CATHETER VCF 5fr***RECALLED SINCE 2016-CALL TO SEE IF AVAILABLE 3/18
|
Facility
|
OP
|
$2,960.00
|
|
| Hospital Charge Code |
2971166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.80 |
| Max. Negotiated Rate |
$11,840.00 |
| Rate for Payer: Aetna Commercial |
$2,664.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,545.60
|
| Rate for Payer: Aetna Managed Medicare |
$828.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,924.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,480.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,420.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,568.80
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$2,723.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,656.42
|
| Rate for Payer: Health EOS Commercial |
$2,634.40
|
| Rate for Payer: HFN Commercial |
$2,723.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,220.00
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,776.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,723.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,450.40
|
| Rate for Payer: Quartz Commercial |
$1,924.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,776.00
|
| Rate for Payer: The Alliance Commercial |
$11,840.00
|
| Rate for Payer: WEA Trust Commercial |
$1,628.00
|
| Rate for Payer: WPS Commercial |
$2,192.47
|
|
|
CATHETER VCF 5fr***RECALLED SINCE 2016-CALL TO SEE IF AVAILABLE 3/18
|
Facility
|
IP
|
$2,960.00
|
|
| Hospital Charge Code |
2971166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,450.40 |
| Max. Negotiated Rate |
$2,723.20 |
| Rate for Payer: Aetna Commercial |
$2,664.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,545.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,568.80
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$2,723.20
|
| Rate for Payer: Health EOS Commercial |
$2,634.40
|
| Rate for Payer: HFN Commercial |
$2,723.20
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,776.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,723.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,450.40
|
| Rate for Payer: Quartz Commercial |
$1,776.00
|
| Rate for Payer: WEA Trust Commercial |
$1,628.00
|
| Rate for Payer: WPS Commercial |
$2,192.47
|
|
|
CATHETER VITEK CEREBRAL
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
2971111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: The Alliance Commercial |
$1,708.00
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER VITEK CEREBRAL
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
2971111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER (VOLCANO) EAGLE EYE GOLD #85900
|
Facility
|
OP
|
$6,605.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2973702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,849.40 |
| Max. Negotiated Rate |
$26,420.00 |
| Rate for Payer: Aetna Commercial |
$5,944.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,849.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,293.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,302.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.65
|
| Rate for Payer: Cash Price |
$1,981.50
|
| Rate for Payer: Cigna Commercial |
$6,076.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,696.16
|
| Rate for Payer: Health EOS Commercial |
$5,878.45
|
| Rate for Payer: HFN Commercial |
$6,076.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,953.75
|
| Rate for Payer: Multiplan Commercial |
$5,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.45
|
| Rate for Payer: Quartz Commercial |
$4,293.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,963.00
|
| Rate for Payer: The Alliance Commercial |
$26,420.00
|
| Rate for Payer: WEA Trust Commercial |
$3,632.75
|
| Rate for Payer: WPS Commercial |
$4,892.32
|
|
|
CATHETER (VOLCANO) EAGLE EYE GOLD #85900
|
Facility
|
IP
|
$6,605.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2973702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,236.45 |
| Max. Negotiated Rate |
$6,076.60 |
| Rate for Payer: Aetna Commercial |
$5,944.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.65
|
| Rate for Payer: Cash Price |
$1,981.50
|
| Rate for Payer: Cigna Commercial |
$6,076.60
|
| Rate for Payer: Health EOS Commercial |
$5,878.45
|
| Rate for Payer: HFN Commercial |
$6,076.60
|
| Rate for Payer: Multiplan Commercial |
$5,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.45
|
| Rate for Payer: Quartz Commercial |
$3,963.00
|
| Rate for Payer: WEA Trust Commercial |
$3,632.75
|
| Rate for Payer: WPS Commercial |
$4,892.32
|
|
