|
CATHETER SINGLE LUMEN KIT AK-04301
|
Facility
IP
|
$375.00
|
|
| Hospital Charge Code |
2963128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.00
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
CATHETER SLIC INFUSION SINGLE ARWSS14701
|
Facility
OP
|
$902.00
|
|
| Hospital Charge Code |
3065499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$3,608.00 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.72
|
| Rate for Payer: Aetna Managed Medicare |
$252.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.76
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$586.30
|
| Rate for Payer: Quartz Medicare Advantage |
$541.20
|
| Rate for Payer: The Alliance Commercial |
$3,608.00
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
CATHETER SLIC INFUSION SINGLE ARWSS14701
|
Facility
IP
|
$902.00
|
|
| Hospital Charge Code |
3065499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.98 |
| Max. Negotiated Rate |
$829.84 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$541.20
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
CATHETERS TRAIL BLAZER 5FR
|
Facility
IP
|
$6,415.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,143.35 |
| Max. Negotiated Rate |
$5,901.80 |
| Rate for Payer: Aetna Commercial |
$5,773.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,399.95
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$5,901.80
|
| Rate for Payer: Health EOS Commercial |
$5,709.35
|
| Rate for Payer: HFN Commercial |
$5,901.80
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,849.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,901.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,143.35
|
| Rate for Payer: Quartz Commercial |
$3,849.00
|
| Rate for Payer: WEA Trust Commercial |
$3,528.25
|
| Rate for Payer: WPS Commercial |
$4,751.59
|
|
|
CATHETERS TRAIL BLAZER 5FR
|
Facility
OP
|
$6,415.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,796.20 |
| Max. Negotiated Rate |
$5,901.80 |
| Rate for Payer: Aetna Commercial |
$5,773.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,516.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,796.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,169.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,207.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,079.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,399.95
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$5,901.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,589.83
|
| Rate for Payer: Health EOS Commercial |
$5,709.35
|
| Rate for Payer: HFN Commercial |
$5,901.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,811.25
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,849.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,901.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,143.35
|
| Rate for Payer: Quartz Commercial |
$4,169.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,849.00
|
| Rate for Payer: WEA Trust Commercial |
$3,528.25
|
| Rate for Payer: WPS Commercial |
$4,751.59
|
|
|
CATHETER SUCTION KIT 10 FR
|
Facility
IP
|
$25.00
|
|
| Hospital Charge Code |
2963479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
CATHETER SUCTION KIT 10 FR
|
Facility
OP
|
$25.00
|
|
| Hospital Charge Code |
2963479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
CATHETER SUCTION KIT 12 FR
|
Facility
OP
|
$85.00
|
|
| Hospital Charge Code |
2963478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
CATHETER SUCTION KIT 12 FR
|
Facility
IP
|
$85.00
|
|
| Hospital Charge Code |
2963478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
CATHETER SUCTION KIT 14 FR 21 4864T
|
Facility
OP
|
$85.00
|
|
| Hospital Charge Code |
2968887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
CATHETER SUCTION KIT 14 FR 21 4864T
|
Facility
IP
|
$85.00
|
|
| Hospital Charge Code |
2968887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
CATHETER SUCTION KIT 5 FR 4863T
|
Facility
IP
|
$82.00
|
|
| Hospital Charge Code |
2969219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
CATHETER SUCTION KIT 5 FR 4863T
|
Facility
OP
|
$82.00
|
|
| Hospital Charge Code |
2969219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
CATHETER SUCTION KIT 8 FR 4867T
|
Facility
IP
|
$24.00
|
|
| Hospital Charge Code |
2963486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
CATHETER SUCTION KIT 8 FR 4867T
|
Facility
OP
|
$24.00
|
|
| Hospital Charge Code |
2963486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.40
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
CATHETER SUPER-KIT MULTI LUMEN #AK-42703-SK
|
Facility
IP
|
$1,278.00
|
|
| Hospital Charge Code |
2973498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.22 |
| Max. Negotiated Rate |
$1,175.76 |
| Rate for Payer: Aetna Commercial |
$1,150.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.34
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,175.76
|
| Rate for Payer: Health EOS Commercial |
$1,137.42
|
| Rate for Payer: HFN Commercial |
$1,175.76
|
| Rate for Payer: Multiplan Commercial |
$1,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$766.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.76
|
| Rate for Payer: Quartz Beloit One Network |
$626.22
|
| Rate for Payer: Quartz Commercial |
$766.80
|
| Rate for Payer: WEA Trust Commercial |
$702.90
|
| Rate for Payer: WPS Commercial |
$946.61
|
|
|
CATHETER SUPER-KIT MULTI LUMEN #AK-42703-SK
|
Facility
OP
|
$1,278.00
|
|
| Hospital Charge Code |
2973498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.84 |
| Max. Negotiated Rate |
$5,112.00 |
| Rate for Payer: Aetna Commercial |
$1,150.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.08
|
| Rate for Payer: Aetna Managed Medicare |
$357.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$830.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$639.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.34
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,175.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.17
|
| Rate for Payer: Health EOS Commercial |
$1,137.42
|
| Rate for Payer: HFN Commercial |
$1,175.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$958.50
|
| Rate for Payer: Multiplan Commercial |
$1,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$766.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.76
|
| Rate for Payer: Quartz Beloit One Network |
$626.22
|
| Rate for Payer: Quartz Commercial |
$830.70
|
| Rate for Payer: Quartz Medicare Advantage |
$766.80
|
| Rate for Payer: The Alliance Commercial |
$5,112.00
|
| Rate for Payer: WEA Trust Commercial |
$702.90
|
| Rate for Payer: WPS Commercial |
$946.61
|
|
|
CATHETER SUPRAPUBIC 14 X 25CM LOOP G30405
|
Facility
IP
|
$1,051.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2969489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$514.99 |
| Max. Negotiated Rate |
$966.92 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.03
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$966.92
|
| Rate for Payer: Health EOS Commercial |
$935.39
|
| Rate for Payer: HFN Commercial |
$966.92
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: NAPHCARE Commercial |
$630.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.92
|
| Rate for Payer: Quartz Beloit One Network |
$514.99
|
| Rate for Payer: Quartz Commercial |
$630.60
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
CATHETER SUPRAPUBIC 14 X 25CM LOOP G30405
|
Facility
OP
|
$1,051.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2969489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.28 |
| Max. Negotiated Rate |
$966.92 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.86
|
| Rate for Payer: Aetna Managed Medicare |
$294.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$683.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.03
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$966.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.14
|
| Rate for Payer: Health EOS Commercial |
$935.39
|
| Rate for Payer: HFN Commercial |
$966.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.25
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: NAPHCARE Commercial |
$630.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.92
|
| Rate for Payer: Quartz Beloit One Network |
$514.99
|
| Rate for Payer: Quartz Commercial |
$683.15
|
| Rate for Payer: Quartz Medicare Advantage |
$630.60
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
CATHETER SUPRAPUBIC 16FR X 22CM RUTNER BALLOON G14920
|
Facility
IP
|
$624.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2965855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
CATHETER SUPRAPUBIC 16FR X 22CM RUTNER BALLOON G14920
|
Facility
OP
|
$624.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2965855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Aetna Managed Medicare |
$174.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$405.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$312.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$299.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.19
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: Quartz Medicare Advantage |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
Catheter,Suprapubic,Cystoscopi C2627
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
4378659
|
|
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
|
|
|
Catheter,Suprapubic,Cystoscopi C2627
|
Professional
|
$46.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
4378659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$43.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Preferred Network Access Commercial |
$43.70
|
| Rate for Payer: Quartz Beloit One Network |
$20.24
|
| Rate for Payer: Quartz Commercial |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
Catheter,Suprapubic,Cystoscopi C2627
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
4378659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$42.32 |
| 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: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
CATHETER SUPRAPUBIC S-CATH 12FR X 42CM 10CC BALLOON OPEN TIP WITH INTRODUCER SET 5753
|
Facility
OP
|
$2,154.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
6166005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$603.12 |
| Max. Negotiated Rate |
$1,981.68 |
| Rate for Payer: Aetna Commercial |
$1,938.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,852.44
|
| Rate for Payer: Aetna Managed Medicare |
$603.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,400.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,077.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,033.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,141.62
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$1,981.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,205.38
|
| Rate for Payer: Health EOS Commercial |
$1,917.06
|
| Rate for Payer: HFN Commercial |
$1,981.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,615.50
|
| Rate for Payer: Multiplan Commercial |
$1,723.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,292.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,981.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.46
|
| Rate for Payer: Quartz Commercial |
$1,400.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,292.40
|
| Rate for Payer: WEA Trust Commercial |
$1,184.70
|
| Rate for Payer: WPS Commercial |
$1,595.47
|
|
