|
STOPCOCK 3 WAY H3FLC
|
Facility
IP
|
$62.00
|
|
| Hospital Charge Code |
6207025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Stopcock 4Way
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
3101775
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Stopcock 4Way
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
3101775
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$42.00
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Stopcock 4Way w/o Tubing
|
Facility
OP
|
$55.00
|
|
| Hospital Charge Code |
3101778
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Stopcock 4Way w/o Tubing
|
Facility
IP
|
$55.00
|
|
| Hospital Charge Code |
3101778
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
STOPCOCK DOUBLE
|
Facility
OP
|
$67.00
|
|
| Hospital Charge Code |
2963687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$40.20
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
STOPCOCK DOUBLE
|
Facility
IP
|
$67.00
|
|
| Hospital Charge Code |
2963687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Stop-Cock Manifold
|
Facility
OP
|
$64.00
|
|
| Hospital Charge Code |
3101779
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.81
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| Rate for Payer: Quartz Medicare Advantage |
$38.40
|
| Rate for Payer: The Alliance Commercial |
$256.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Stop-Cock Manifold
|
Facility
IP
|
$64.00
|
|
| Hospital Charge Code |
3101779
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Stopcock - Peripheral IV Equipment:
|
Facility
IP
|
$45.00
|
|
| Hospital Charge Code |
2999913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
Stopcock - Peripheral IV Equipment:
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
2999913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.18
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$27.00
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
STOPCOCK W/O TUBING MX5341L
|
Facility
OP
|
$46.00
|
|
| Hospital Charge Code |
2963763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.74
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$29.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27.60
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
STOPCOCK W/O TUBING MX5341L
|
Facility
IP
|
$46.00
|
|
| Hospital Charge Code |
2963763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$42.32 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$27.60
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
STRABISMUS REPAIR
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960393
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
STRABISMUS REPAIR
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960393
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Straight Catheter 51701
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5879791
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight Catheter 51701
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5879791
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$98.25
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight/Intermittent* - Urinary catheter type:
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5877764
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight/Intermittent* - Urinary catheter type:
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5877764
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$98.25
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight/Intermittent - Urinary Catheter Type
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
2999938
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$98.25
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight/Intermittent - Urinary Catheter Type
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
2999938
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight/Intermittent* - Urinary Catheter Type:
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5510858
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$98.25
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Straight/Intermittent* - Urinary Catheter Type:
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5510858
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
STRAIGHT PLATE LOCKING 4HL SS AR-8943C-04
|
Facility
OP
|
$4,426.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.28 |
| Max. Negotiated Rate |
$4,071.92 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.79
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,319.50
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,876.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.60
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
STRAIGHT PLATE LOCKING 4HL SS AR-8943C-04
|
Facility
IP
|
$4,426.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.74 |
| Max. Negotiated Rate |
$4,071.92 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,655.60
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
