|
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 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 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 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 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
|
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 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 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
|
|
|
CATHETER OPEN END 6FR G15942
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
2965856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
CATHETER OPEN END 6FR G15942
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
2965856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
CATHETER OPTI-Q SvO2 52509-14
|
Facility
|
IP
|
$3,016.00
|
|
| Hospital Charge Code |
2963033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,536.95 |
| Max. Negotiated Rate |
$2,885.71 |
| Rate for Payer: Aetna Commercial |
$2,822.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.42
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cigna Commercial |
$2,885.71
|
| Rate for Payer: Health EOS Commercial |
$2,791.61
|
| Rate for Payer: HFN Commercial |
$2,885.71
|
| Rate for Payer: Multiplan Commercial |
$2,509.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,885.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.95
|
| Rate for Payer: Quartz Commercial |
$1,881.98
|
| Rate for Payer: WEA Trust Commercial |
$1,725.15
|
| Rate for Payer: WPS Commercial |
$2,323.22
|
|
|
CATHETER OPTI-Q SvO2 52509-14
|
Facility
|
OP
|
$3,016.00
|
|
| Hospital Charge Code |
2963033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.26 |
| Max. Negotiated Rate |
$2,885.71 |
| Rate for Payer: Aetna Commercial |
$2,822.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.51
|
| Rate for Payer: Aetna Managed Medicare |
$878.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,038.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.42
|
| Rate for Payer: Cash Price |
$904.80
|
| Rate for Payer: Cigna Commercial |
$2,885.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.31
|
| Rate for Payer: Health EOS Commercial |
$2,791.61
|
| Rate for Payer: HFN Commercial |
$2,885.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.48
|
| Rate for Payer: Multiplan Commercial |
$2,509.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,881.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,885.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.95
|
| Rate for Payer: Quartz Commercial |
$2,038.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,881.98
|
| Rate for Payer: The Alliance Commercial |
$1,568.32
|
| Rate for Payer: WEA Trust Commercial |
$1,725.15
|
| Rate for Payer: WPS Commercial |
$2,323.22
|
|
|
CATHETER PERIFIX OPEN TIP EC200 333520
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
5520794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CATHETER PERIFIX OPEN TIP EC200 333520
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS C1755
|
| Hospital Charge Code |
5520794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$54.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| Rate for Payer: Quartz Medicare Advantage |
$117.31
|
| Rate for Payer: The Alliance Commercial |
$97.76
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CATHETER PHIL FOLLOWER 22F
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2963085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
CATHETER PHIL FOLLOWER 22F
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2963085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
CATHETER PICC PWRD DOUBLE 5 FR. 3275355F
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2962940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$741.47 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
CATHETER PICC PWRD DOUBLE 5 FR. 3275355F
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2962940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Aetna Managed Medicare |
$423.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$983.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.81
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: NAPHCARE Commercial |
$907.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$983.58
|
| Rate for Payer: Quartz Medicare Advantage |
$907.92
|
| Rate for Payer: The Alliance Commercial |
$756.60
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
CATHETER PICC SINGLE 5 FR.
|
Facility
|
OP
|
$1,104.00
|
|
| Hospital Charge Code |
2963296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.48 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$321.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.53
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: Quartz Medicare Advantage |
$688.90
|
| Rate for Payer: The Alliance Commercial |
$574.08
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
