|
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 |
$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 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 |
$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 URETERAL ADAPTER 140000
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2963898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$13.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$14.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$11.44
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
CATHETER URETERAL ADAPTER 140000
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2963898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$13.73
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
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 |
$359.92 |
| Max. Negotiated Rate |
$1,182.60 |
| Rate for Payer: Aetna Commercial |
$1,156.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.48
|
| Rate for Payer: Aetna Managed Medicare |
$359.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$835.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$642.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$617.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.28
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,182.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$719.35
|
| Rate for Payer: Health EOS Commercial |
$1,144.04
|
| Rate for Payer: HFN Commercial |
$1,182.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$964.08
|
| Rate for Payer: Multiplan Commercial |
$1,028.35
|
| Rate for Payer: NAPHCARE Commercial |
$771.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,182.60
|
| Rate for Payer: Quartz Beloit One Network |
$629.87
|
| Rate for Payer: Quartz Commercial |
$835.54
|
| Rate for Payer: Quartz Medicare Advantage |
$771.26
|
| Rate for Payer: The Alliance Commercial |
$642.72
|
| Rate for Payer: WEA Trust Commercial |
$706.99
|
| Rate for Payer: WPS Commercial |
$952.09
|
|
|
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 |
$629.87 |
| Max. Negotiated Rate |
$1,182.60 |
| Rate for Payer: Aetna Commercial |
$1,156.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.28
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,182.60
|
| Rate for Payer: Health EOS Commercial |
$1,144.04
|
| Rate for Payer: HFN Commercial |
$1,182.60
|
| Rate for Payer: Multiplan Commercial |
$1,028.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,182.60
|
| Rate for Payer: Quartz Beloit One Network |
$629.87
|
| Rate for Payer: Quartz Commercial |
$771.26
|
| Rate for Payer: WEA Trust Commercial |
$706.99
|
| Rate for Payer: WPS Commercial |
$952.09
|
|
|
CATHETER URETERAL DUAL LUMEN 405-100
|
Facility
|
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2964806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.29 |
| Max. Negotiated Rate |
$1,545.23 |
| Rate for Payer: Aetna Commercial |
$1,511.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,444.46
|
| Rate for Payer: Aetna Managed Medicare |
$470.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,091.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$806.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.19
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,545.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.93
|
| Rate for Payer: Health EOS Commercial |
$1,494.84
|
| Rate for Payer: HFN Commercial |
$1,545.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,259.70
|
| Rate for Payer: Multiplan Commercial |
$1,343.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,007.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,545.23
|
| Rate for Payer: Quartz Beloit One Network |
$823.00
|
| Rate for Payer: Quartz Commercial |
$1,091.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,007.76
|
| Rate for Payer: The Alliance Commercial |
$839.80
|
| Rate for Payer: WEA Trust Commercial |
$923.78
|
| Rate for Payer: WPS Commercial |
$1,244.03
|
|
|
CATHETER URETERAL DUAL LUMEN 405-100
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2964806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.00 |
| Max. Negotiated Rate |
$1,545.23 |
| Rate for Payer: Aetna Commercial |
$1,511.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,444.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.19
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,545.23
|
| Rate for Payer: Health EOS Commercial |
$1,494.84
|
| Rate for Payer: HFN Commercial |
$1,545.23
|
| Rate for Payer: Multiplan Commercial |
$1,343.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,545.23
|
| Rate for Payer: Quartz Beloit One Network |
$823.00
|
| Rate for Payer: Quartz Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$923.78
|
| Rate for Payer: WPS Commercial |
$1,244.03
|
|
|
CATHETER URETHERAL 12F 400612
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
2963384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
CATHETER URETHERAL 12F 400612
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
2963384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
CATHETER URETHERAL 8 FR 400608
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
2963445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$18.10
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.10
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
CATHETER URETHERAL 8 FR 400608
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
2963445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
CATHETER URETHRAL 14FR 400614
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
CATHETER URETHRAL 14FR 400614
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
CATHETER URETHRAL 16FR 400616
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
2962821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
CATHETER URETHRAL 16FR 400616
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
2962821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
CATHETER VANSCHIE5
|
Facility
|
OP
|
$556.00
|
|
| Hospital Charge Code |
2971412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
CATHETER VANSCHIE5
|
Facility
|
IP
|
$556.00
|
|
| Hospital Charge Code |
2971412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
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 |
$1,508.42 |
| Max. Negotiated Rate |
$2,832.13 |
| Rate for Payer: Aetna Commercial |
$2,770.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,647.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,631.55
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$2,832.13
|
| Rate for Payer: Health EOS Commercial |
$2,739.78
|
| Rate for Payer: HFN Commercial |
$2,832.13
|
| Rate for Payer: Multiplan Commercial |
$2,462.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,832.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,508.42
|
| Rate for Payer: Quartz Commercial |
$1,847.04
|
| Rate for Payer: WEA Trust Commercial |
$1,693.12
|
| Rate for Payer: WPS Commercial |
$2,280.09
|
|
|
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 |
$861.95 |
| Max. Negotiated Rate |
$2,832.13 |
| Rate for Payer: Aetna Commercial |
$2,770.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,647.42
|
| Rate for Payer: Aetna Managed Medicare |
$861.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,000.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,539.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,477.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,631.55
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$2,832.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,722.72
|
| Rate for Payer: Health EOS Commercial |
$2,739.78
|
| Rate for Payer: HFN Commercial |
$2,832.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,308.80
|
| Rate for Payer: Multiplan Commercial |
$2,462.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,847.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,832.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,508.42
|
| Rate for Payer: Quartz Commercial |
$2,000.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,847.04
|
| Rate for Payer: The Alliance Commercial |
$1,539.20
|
| Rate for Payer: WEA Trust Commercial |
$1,693.12
|
| Rate for Payer: WPS Commercial |
$2,280.09
|
|
|
CATHETER VITEK CEREBRAL
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
2971111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER VITEK CEREBRAL
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
2971111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER (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 |
$3,365.91 |
| Max. Negotiated Rate |
$6,319.66 |
| Rate for Payer: Aetna Commercial |
$6,182.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,907.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,640.68
|
| Rate for Payer: Cash Price |
$1,981.50
|
| Rate for Payer: Cigna Commercial |
$6,319.66
|
| Rate for Payer: Health EOS Commercial |
$6,113.59
|
| Rate for Payer: HFN Commercial |
$6,319.66
|
| Rate for Payer: Multiplan Commercial |
$5,495.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,319.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,365.91
|
| Rate for Payer: Quartz Commercial |
$4,121.52
|
| Rate for Payer: WEA Trust Commercial |
$3,778.06
|
| Rate for Payer: WPS Commercial |
$5,087.83
|
|
|
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 |
$1,923.38 |
| Max. Negotiated Rate |
$6,319.66 |
| Rate for Payer: Aetna Commercial |
$6,182.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,907.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,923.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,464.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,434.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,297.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,640.68
|
| Rate for Payer: Cash Price |
$1,981.50
|
| Rate for Payer: Cigna Commercial |
$6,319.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,844.11
|
| Rate for Payer: Health EOS Commercial |
$6,113.59
|
| Rate for Payer: HFN Commercial |
$6,319.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,151.90
|
| Rate for Payer: Multiplan Commercial |
$5,495.36
|
| Rate for Payer: NAPHCARE Commercial |
$4,121.52
|
| Rate for Payer: Preferred Network Access Commercial |
$6,319.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,365.91
|
| Rate for Payer: Quartz Commercial |
$4,464.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4,121.52
|
| Rate for Payer: The Alliance Commercial |
$3,434.60
|
| Rate for Payer: WEA Trust Commercial |
$3,778.06
|
| Rate for Payer: WPS Commercial |
$5,087.83
|
|
|
CATHETER (VOLCANO) VISIONS PV MODEL 86700
|
Facility
|
IP
|
$3,973.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
3107480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,024.64 |
| Max. Negotiated Rate |
$3,801.37 |
| Rate for Payer: Aetna Commercial |
$3,718.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,553.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,189.92
|
| Rate for Payer: Cash Price |
$1,191.90
|
| Rate for Payer: Cigna Commercial |
$3,801.37
|
| Rate for Payer: Health EOS Commercial |
$3,677.41
|
| Rate for Payer: HFN Commercial |
$3,801.37
|
| Rate for Payer: Multiplan Commercial |
$3,305.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,024.64
|
| Rate for Payer: Quartz Commercial |
$2,479.15
|
| Rate for Payer: WEA Trust Commercial |
$2,272.56
|
| Rate for Payer: WPS Commercial |
$3,060.40
|
|
