|
CATHETER MALECOT 14 FRENCH
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2963721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CATHETER MALECOT 16 FRENCH
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2969217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CATHETER MALECOT 16 FRENCH
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2969217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$152.36
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CATHETER MALECOT 20 FRENCH
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2963163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$152.36
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CATHETER MALECOT 20 FRENCH
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2963163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CATHETER MALECOT 22FR 086022
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963412
|
|
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 22FR 086022
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963412
|
|
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 24FR 086024
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963179
|
|
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 24FR 086024
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963179
|
|
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 28 FRENCH
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963154
|
|
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 28 FRENCH
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963154
|
|
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 30 FRENCH
|
Facility
|
OP
|
$283.00
|
|
| Hospital Charge Code |
2963153
|
|
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 30 FRENCH
|
Facility
|
IP
|
$283.00
|
|
| Hospital Charge Code |
2963153
|
|
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 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 32fr
|
Facility
|
OP
|
$302.00
|
|
| Hospital Charge Code |
2963884
|
|
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 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 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 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 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 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
|
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 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
|
|
