|
CATHETER EMBOLECTOMY 3FR A4403/E1801-38
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.08 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$909.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.46
|
| Rate for Payer: Aetna Managed Medicare |
$283.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.83
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna Commercial |
$930.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.76
|
| Rate for Payer: Health EOS Commercial |
$899.79
|
| Rate for Payer: HFN Commercial |
$930.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.25
|
| Rate for Payer: Multiplan Commercial |
$808.80
|
| Rate for Payer: NAPHCARE Commercial |
$606.60
|
| Rate for Payer: Preferred Network Access Commercial |
$930.12
|
| Rate for Payer: Quartz Beloit One Network |
$495.39
|
| Rate for Payer: Quartz Commercial |
$657.15
|
| Rate for Payer: Quartz Medicare Advantage |
$606.60
|
| Rate for Payer: The Alliance Commercial |
$4,044.00
|
| Rate for Payer: WEA Trust Commercial |
$556.05
|
| Rate for Payer: WPS Commercial |
$748.85
|
|
|
CATHETER EMBOLECTOMY 4FR A4548
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Aetna Managed Medicare |
$350.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$812.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$699.50
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$812.50
|
| Rate for Payer: Quartz Medicare Advantage |
$750.00
|
| Rate for Payer: The Alliance Commercial |
$5,000.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
CATHETER EMBOLECTOMY 4FR A4548
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
CATHETER EMMETT 26FR 30CC 3-WAY 0138L26
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
5414944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
CATHETER EMMETT 26FR 30CC 3-WAY 0138L26
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
5414944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
CATHETER EPISTAXIS 20-10701
|
Facility
|
OP
|
$986.00
|
|
| Hospital Charge Code |
2963459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.08 |
| Max. Negotiated Rate |
$3,944.00 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.96
|
| Rate for Payer: Aetna Managed Medicare |
$276.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$493.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$473.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.58
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$907.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.77
|
| Rate for Payer: Health EOS Commercial |
$877.54
|
| Rate for Payer: HFN Commercial |
$907.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.50
|
| Rate for Payer: Multiplan Commercial |
$788.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.60
|
| Rate for Payer: Preferred Network Access Commercial |
$907.12
|
| Rate for Payer: Quartz Beloit One Network |
$483.14
|
| Rate for Payer: Quartz Commercial |
$640.90
|
| Rate for Payer: Quartz Medicare Advantage |
$591.60
|
| Rate for Payer: The Alliance Commercial |
$3,944.00
|
| Rate for Payer: WEA Trust Commercial |
$542.30
|
| Rate for Payer: WPS Commercial |
$730.33
|
|
|
CATHETER EPISTAXIS 20-10701
|
Facility
|
IP
|
$986.00
|
|
| Hospital Charge Code |
2963459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.14 |
| Max. Negotiated Rate |
$907.12 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.58
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$907.12
|
| Rate for Payer: Health EOS Commercial |
$877.54
|
| Rate for Payer: HFN Commercial |
$907.12
|
| Rate for Payer: Multiplan Commercial |
$788.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.60
|
| Rate for Payer: Preferred Network Access Commercial |
$907.12
|
| Rate for Payer: Quartz Beloit One Network |
$483.14
|
| Rate for Payer: Quartz Commercial |
$591.60
|
| Rate for Payer: WEA Trust Commercial |
$542.30
|
| Rate for Payer: WPS Commercial |
$730.33
|
|
|
CATHETER ERCP
|
Facility
|
IP
|
$1,138.00
|
|
| Hospital Charge Code |
2963461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$557.62 |
| Max. Negotiated Rate |
$1,046.96 |
| Rate for Payer: Aetna Commercial |
$1,024.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.14
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,046.96
|
| Rate for Payer: Health EOS Commercial |
$1,012.82
|
| Rate for Payer: HFN Commercial |
$1,046.96
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: NAPHCARE Commercial |
$682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.96
|
| Rate for Payer: Quartz Beloit One Network |
$557.62
|
| Rate for Payer: Quartz Commercial |
$682.80
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
CATHETER ERCP
|
Facility
|
OP
|
$1,138.00
|
|
| Hospital Charge Code |
2963461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.64 |
| Max. Negotiated Rate |
$4,552.00 |
| Rate for Payer: Aetna Commercial |
$1,024.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Aetna Managed Medicare |
$318.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$739.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$569.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$546.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.14
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,046.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.82
|
| Rate for Payer: Health EOS Commercial |
$1,012.82
|
| Rate for Payer: HFN Commercial |
$1,046.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$853.50
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: NAPHCARE Commercial |
$682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.96
|
| Rate for Payer: Quartz Beloit One Network |
$557.62
|
| Rate for Payer: Quartz Commercial |
$739.70
|
| Rate for Payer: Quartz Medicare Advantage |
$682.80
|
| Rate for Payer: The Alliance Commercial |
$4,552.00
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
CATHETER EXCHANGE, DIALYSIS
|
Facility
|
OP
|
$1,872.00
|
|
| Hospital Charge Code |
6209793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Aetna Commercial |
$1,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.92
|
| Rate for Payer: Aetna Managed Medicare |
$524.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,216.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$936.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$898.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.16
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,722.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,047.57
|
| Rate for Payer: Health EOS Commercial |
$1,666.08
|
| Rate for Payer: HFN Commercial |
$1,722.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,404.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.24
|
| Rate for Payer: Quartz Beloit One Network |
$917.28
|
| Rate for Payer: Quartz Commercial |
$1,216.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,123.20
|
| Rate for Payer: The Alliance Commercial |
$7,488.00
|
| Rate for Payer: WEA Trust Commercial |
$1,029.60
|
| Rate for Payer: WPS Commercial |
$1,386.59
|
|
|
CATHETER EXCHANGE, DIALYSIS
|
Facility
|
IP
|
$1,872.00
|
|
| Hospital Charge Code |
6209793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$917.28 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.16
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,722.24
|
| Rate for Payer: Health EOS Commercial |
$1,666.08
|
| Rate for Payer: HFN Commercial |
$1,722.24
|
| Rate for Payer: Multiplan Commercial |
$1,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.24
|
| Rate for Payer: Quartz Beloit One Network |
$917.28
|
| Rate for Payer: Quartz Commercial |
$1,123.20
|
| Rate for Payer: WEA Trust Commercial |
$1,029.60
|
| Rate for Payer: WPS Commercial |
$1,386.59
|
|
|
CATHETER FOLEY 10FR 3cc I.C 0165SI10
|
Facility
|
OP
|
$263.00
|
|
| Hospital Charge Code |
2963280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$1,052.00 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.17
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.25
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$170.95
|
| Rate for Payer: Quartz Medicare Advantage |
$157.80
|
| Rate for Payer: The Alliance Commercial |
$1,052.00
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
CATHETER FOLEY 10FR 3cc I.C 0165SI10
|
Facility
|
IP
|
$263.00
|
|
| Hospital Charge Code |
2963280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$157.80
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
CATHETER FOLEY 12FR 5CC 2-WAY BARDEX 0165SI12
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
CATHETER FOLEY 12FR 5CC 2-WAY BARDEX 0165SI12
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
CATHETER FOLEY 12FR 5CC 2-WAY SILICONE RUSCH 171305120
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS A4344
|
| Hospital Charge Code |
5349200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna Commercial |
$729.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$696.60
|
| Rate for Payer: Aetna Managed Medicare |
$226.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$526.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.30
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$745.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.28
|
| Rate for Payer: Health EOS Commercial |
$720.90
|
| Rate for Payer: HFN Commercial |
$745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$607.50
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: NAPHCARE Commercial |
$486.00
|
| Rate for Payer: Preferred Network Access Commercial |
$745.20
|
| Rate for Payer: Quartz Beloit One Network |
$396.90
|
| Rate for Payer: Quartz Commercial |
$526.50
|
| Rate for Payer: Quartz Medicare Advantage |
$486.00
|
| Rate for Payer: The Alliance Commercial |
$3,240.00
|
| Rate for Payer: WEA Trust Commercial |
$445.50
|
| Rate for Payer: WPS Commercial |
$599.97
|
|
|
CATHETER FOLEY 12FR 5CC 2-WAY SILICONE RUSCH 171305120
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS A4344
|
| Hospital Charge Code |
5349200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna Commercial |
$729.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$696.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.30
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$745.20
|
| Rate for Payer: Health EOS Commercial |
$720.90
|
| Rate for Payer: HFN Commercial |
$745.20
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: NAPHCARE Commercial |
$486.00
|
| Rate for Payer: Preferred Network Access Commercial |
$745.20
|
| Rate for Payer: Quartz Beloit One Network |
$396.90
|
| Rate for Payer: Quartz Commercial |
$486.00
|
| Rate for Payer: WEA Trust Commercial |
$445.50
|
| Rate for Payer: WPS Commercial |
$599.97
|
|
|
CATHETER FOLEY 14FR 10ML 2-WAY 100% SILICONE DYND11501
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
6175436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$23.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$49.80
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
CATHETER FOLEY 14FR 10ML 2-WAY 100% SILICONE DYND11501
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
6175436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
CATHETER FOLEY 14FR 30CC 0166SI14
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
2963233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.50
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Quartz Medicare Advantage |
$25.20
|
| Rate for Payer: The Alliance Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
CATHETER FOLEY 14FR 30CC 0166SI14
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
2963233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
CATHETER FOLEY 14FR 5CC 2-WAY COUDE SILICONE LF 0170SI14
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS A4340
|
| Hospital Charge Code |
5563239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.21 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$476.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.37
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$486.68
|
| Rate for Payer: Health EOS Commercial |
$470.81
|
| Rate for Payer: HFN Commercial |
$486.68
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: NAPHCARE Commercial |
$317.40
|
| Rate for Payer: Preferred Network Access Commercial |
$486.68
|
| Rate for Payer: Quartz Beloit One Network |
$259.21
|
| Rate for Payer: Quartz Commercial |
$317.40
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
CATHETER FOLEY 14FR 5CC 2-WAY COUDE SILICONE LF 0170SI14
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS A4340
|
| Hospital Charge Code |
5563239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.12 |
| Max. Negotiated Rate |
$2,116.00 |
| Rate for Payer: Aetna Commercial |
$476.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Aetna Managed Medicare |
$148.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$343.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$253.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.37
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$486.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.03
|
| Rate for Payer: Health EOS Commercial |
$470.81
|
| Rate for Payer: HFN Commercial |
$486.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.75
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: NAPHCARE Commercial |
$317.40
|
| Rate for Payer: Preferred Network Access Commercial |
$486.68
|
| Rate for Payer: Quartz Beloit One Network |
$259.21
|
| Rate for Payer: Quartz Commercial |
$343.85
|
| Rate for Payer: Quartz Medicare Advantage |
$317.40
|
| Rate for Payer: The Alliance Commercial |
$2,116.00
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
CATHETER FOLEY 14FR 5CC 2-WAY LATEX 0165SI14
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
2963279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
CATHETER FOLEY 14FR 5CC 2-WAY LATEX 0165SI14
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
2963279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
