|
CATHETER MALECOT 32fr
|
Facility
|
IP
|
$302.00
|
|
| Hospital Charge Code |
2963884
|
|
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 MALECOT 34 FRENCH
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CATHETER MALECOT 34 FRENCH
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$82.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.74
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$176.59
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$176.59
|
| Rate for Payer: The Alliance Commercial |
$147.16
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CATHETER MALECOT 36fr
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$82.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.74
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$176.59
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$176.59
|
| Rate for Payer: The Alliance Commercial |
$147.16
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CATHETER MALECOT 36fr
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CATHETER MALECOT 40 FR
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$82.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.74
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$176.59
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$176.59
|
| Rate for Payer: The Alliance Commercial |
$147.16
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CATHETER MALECOT 40 FR
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
CATHETER MALE EXTERNAL LARGE 36MM 37104
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2963330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
CATHETER MALE EXTERNAL LARGE 36MM 37104
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2963330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
CATHETER MALE EXTERNAL SMALL 25MM 37101
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2963329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
CATHETER MALE EXTERNAL SMALL 25MM 37101
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2963329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
CATHETER MOTARJEME 5FR 5591-A3
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
2970952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$315.74 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Aetna Managed Medicare |
$96.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.06
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.40
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: NAPHCARE Commercial |
$205.92
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$223.08
|
| Rate for Payer: Quartz Medicare Advantage |
$205.92
|
| Rate for Payer: The Alliance Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
CATHETER MOTARJEME 5FR 5591-A3
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
2970952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$315.74 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$205.92
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
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 |
$277.80 |
| Max. Negotiated Rate |
$912.79 |
| Rate for Payer: Aetna Commercial |
$892.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.84
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$912.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.23
|
| Rate for Payer: Health EOS Commercial |
$883.02
|
| Rate for Payer: HFN Commercial |
$912.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.12
|
| Rate for Payer: Multiplan Commercial |
$793.73
|
| Rate for Payer: NAPHCARE Commercial |
$595.30
|
| Rate for Payer: Preferred Network Access Commercial |
$912.79
|
| Rate for Payer: Quartz Beloit One Network |
$486.16
|
| Rate for Payer: Quartz Commercial |
$644.90
|
| Rate for Payer: Quartz Medicare Advantage |
$595.30
|
| Rate for Payer: The Alliance Commercial |
$496.08
|
| Rate for Payer: WEA Trust Commercial |
$545.69
|
| Rate for Payer: WPS Commercial |
$734.87
|
|
|
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 |
$486.16 |
| Max. Negotiated Rate |
$912.79 |
| Rate for Payer: Aetna Commercial |
$892.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.84
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna Commercial |
$912.79
|
| Rate for Payer: Health EOS Commercial |
$883.02
|
| Rate for Payer: HFN Commercial |
$912.79
|
| Rate for Payer: Multiplan Commercial |
$793.73
|
| Rate for Payer: Preferred Network Access Commercial |
$912.79
|
| Rate for Payer: Quartz Beloit One Network |
$486.16
|
| Rate for Payer: Quartz Commercial |
$595.30
|
| Rate for Payer: WEA Trust Commercial |
$545.69
|
| Rate for Payer: WPS Commercial |
$734.87
|
|
|
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 |
$410.01 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Aetna Managed Medicare |
$410.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.46
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.24
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$878.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$951.81
|
| Rate for Payer: Quartz Medicare Advantage |
$878.59
|
| Rate for Payer: The Alliance Commercial |
$732.16
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
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 |
$717.52 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$878.59
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
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 |
$724.51 |
| Max. Negotiated Rate |
$2,380.52 |
| Rate for Payer: Aetna Commercial |
$2,328.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| Rate for Payer: Aetna Managed Medicare |
$724.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,681.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,242.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.39
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,380.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.02
|
| Rate for Payer: Health EOS Commercial |
$2,302.89
|
| Rate for Payer: HFN Commercial |
$2,380.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,940.64
|
| Rate for Payer: Multiplan Commercial |
$2,070.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,552.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.88
|
| Rate for Payer: Quartz Commercial |
$1,681.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,552.51
|
| Rate for Payer: The Alliance Commercial |
$1,293.76
|
| Rate for Payer: WEA Trust Commercial |
$1,423.14
|
| Rate for Payer: WPS Commercial |
$1,916.51
|
|
|
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 |
$1,267.88 |
| Max. Negotiated Rate |
$2,380.52 |
| Rate for Payer: Aetna Commercial |
$2,328.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.39
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,380.52
|
| Rate for Payer: Health EOS Commercial |
$2,302.89
|
| Rate for Payer: HFN Commercial |
$2,380.52
|
| Rate for Payer: Multiplan Commercial |
$2,070.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.88
|
| Rate for Payer: Quartz Commercial |
$1,552.51
|
| Rate for Payer: WEA Trust Commercial |
$1,423.14
|
| Rate for Payer: WPS Commercial |
$1,916.51
|
|
|
CATHETER OPEN END 5FR G14274
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2965533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.91 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$55.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.74
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: Quartz Medicare Advantage |
$119.81
|
| Rate for Payer: The Alliance Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
CATHETER OPEN END 5FR G14274
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
2965533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$119.81
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
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 |
$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 OPEN END 5FR URETERAL M0064002010
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
4520017
|
|
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 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 |
$145.75 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
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 |
$83.28 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$83.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$193.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.45
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.08
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$178.46
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$193.34
|
| Rate for Payer: Quartz Medicare Advantage |
$178.46
|
| Rate for Payer: The Alliance Commercial |
$148.72
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
