|
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
|
|
|
CATHETER SUPRAPUBIC S-CATH 14FR X 42CM 10CC BALLOON OPEN TIP WITH INTRODUCER SET 5757
|
Facility
IP
|
$2,668.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5385015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,307.32 |
| Max. Negotiated Rate |
$2,454.56 |
| Rate for Payer: Aetna Commercial |
$2,401.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,414.04
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,454.56
|
| Rate for Payer: Health EOS Commercial |
$2,374.52
|
| Rate for Payer: HFN Commercial |
$2,454.56
|
| Rate for Payer: Multiplan Commercial |
$2,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,454.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,307.32
|
| Rate for Payer: Quartz Commercial |
$1,600.80
|
| Rate for Payer: WEA Trust Commercial |
$1,467.40
|
| Rate for Payer: WPS Commercial |
$1,976.19
|
|
|
CATHETER SUPRAPUBIC S-CATH 14FR X 42CM 10CC BALLOON OPEN TIP WITH INTRODUCER SET 5757
|
Facility
OP
|
$2,668.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5385015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.04 |
| Max. Negotiated Rate |
$2,454.56 |
| Rate for Payer: Aetna Commercial |
$2,401.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,294.48
|
| Rate for Payer: Aetna Managed Medicare |
$747.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,734.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,334.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,280.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,414.04
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,454.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,493.01
|
| Rate for Payer: Health EOS Commercial |
$2,374.52
|
| Rate for Payer: HFN Commercial |
$2,454.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,001.00
|
| Rate for Payer: Multiplan Commercial |
$2,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,454.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,307.32
|
| Rate for Payer: Quartz Commercial |
$1,734.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,600.80
|
| Rate for Payer: WEA Trust Commercial |
$1,467.40
|
| Rate for Payer: WPS Commercial |
$1,976.19
|
|
|
CATHETER SUPRAPUBIC S-CATH 16FR X 42CM 10CC BALLOON OPEN TIP WITH INTRODUCER SET 5759
|
Facility
IP
|
$2,154.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
6163649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,055.46 |
| Max. Negotiated Rate |
$1,981.68 |
| Rate for Payer: Aetna Commercial |
$1,938.60
|
| 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: Health EOS Commercial |
$1,917.06
|
| Rate for Payer: HFN Commercial |
$1,981.68
|
| 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 |
$1,292.40
|
| Rate for Payer: WEA Trust Commercial |
$1,184.70
|
| Rate for Payer: WPS Commercial |
$1,595.47
|
|
|
CATHETER SUPRAPUBIC S-CATH 16FR X 42CM 10CC BALLOON OPEN TIP WITH INTRODUCER SET 5759
|
Facility
OP
|
$2,154.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
6163649
|
|
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
|
|
|
CATHETER SUPRAPUBIC SOF-FLEX 14FR x 23CM G14934
|
Facility
OP
|
$1,051.00
|
|
| Hospital Charge Code |
2974020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.28 |
| Max. Negotiated Rate |
$4,204.00 |
| 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: The Alliance Commercial |
$4,204.00
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
CATHETER SUPRAPUBIC SOF-FLEX 14FR x 23CM G14934
|
Facility
IP
|
$1,051.00
|
|
| Hospital Charge Code |
2974020
|
|
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 SUPRAFLEX 5-10ML BALLOON 1707031120
|
Facility
IP
|
$1,357.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5307033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.93 |
| Max. Negotiated Rate |
$1,248.44 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.21
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,248.44
|
| Rate for Payer: Health EOS Commercial |
$1,207.73
|
| Rate for Payer: HFN Commercial |
$1,248.44
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$814.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.44
|
| Rate for Payer: Quartz Beloit One Network |
$664.93
|
| Rate for Payer: Quartz Commercial |
$814.20
|
| Rate for Payer: WEA Trust Commercial |
$746.35
|
| Rate for Payer: WPS Commercial |
$1,005.13
|
|
|
CATHETER SUPRAPUBIC SUPRAFLEX 5-10ML BALLOON 1707031120
|
Facility
OP
|
$1,357.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5307033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.96 |
| Max. Negotiated Rate |
$1,248.44 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.02
|
| Rate for Payer: Aetna Managed Medicare |
$379.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$678.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.21
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,248.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.38
|
| Rate for Payer: Health EOS Commercial |
$1,207.73
|
| Rate for Payer: HFN Commercial |
$1,248.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,017.75
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$814.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.44
|
| Rate for Payer: Quartz Beloit One Network |
$664.93
|
| Rate for Payer: Quartz Commercial |
$882.05
|
| Rate for Payer: Quartz Medicare Advantage |
$814.20
|
| Rate for Payer: WEA Trust Commercial |
$746.35
|
| Rate for Payer: WPS Commercial |
$1,005.13
|
|
|
CATHETER TEMPO 5FR RENAL DOUBLE A-2 450-589
|
Facility
OP
|
$451.00
|
|
| Hospital Charge Code |
2971154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$1,804.00 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Aetna Managed Medicare |
$126.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.03
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$414.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.38
|
| Rate for Payer: Health EOS Commercial |
$401.39
|
| Rate for Payer: HFN Commercial |
$414.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.25
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: NAPHCARE Commercial |
$270.60
|
| Rate for Payer: Preferred Network Access Commercial |
$414.92
|
| Rate for Payer: Quartz Beloit One Network |
$220.99
|
| Rate for Payer: Quartz Commercial |
$293.15
|
| Rate for Payer: Quartz Medicare Advantage |
$270.60
|
| Rate for Payer: The Alliance Commercial |
$1,804.00
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
CATHETER TEMPO 5FR RENAL DOUBLE A-2 450-589
|
Facility
IP
|
$451.00
|
|
| Hospital Charge Code |
2971154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.99 |
| Max. Negotiated Rate |
$414.92 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.03
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$414.92
|
| Rate for Payer: Health EOS Commercial |
$401.39
|
| Rate for Payer: HFN Commercial |
$414.92
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: NAPHCARE Commercial |
$270.60
|
| Rate for Payer: Preferred Network Access Commercial |
$414.92
|
| Rate for Payer: Quartz Beloit One Network |
$220.99
|
| Rate for Payer: Quartz Commercial |
$270.60
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
CATHETER THORACIC 24 FR 14724****DISC
|
Facility
OP
|
$427.00
|
|
| Hospital Charge Code |
3779538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: The Alliance Commercial |
$1,708.00
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
CATHETER THORACIC 24 FR 14724****DISC
|
Facility
IP
|
$427.00
|
|
| Hospital Charge Code |
3779538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
Catheter Tip Culture
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
979909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Catheter Tip Culture
|
Professional
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
979909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$37.93
|
|
|
Catheter Tip Culture
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
979909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
CATHETER TRAY 12FR DUAL LUMAN 0600620
|
Facility
IP
|
$3,443.00
|
|
| Hospital Charge Code |
2963100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,687.07 |
| Max. Negotiated Rate |
$3,167.56 |
| Rate for Payer: Aetna Commercial |
$3,098.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,824.79
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cigna Commercial |
$3,167.56
|
| Rate for Payer: Health EOS Commercial |
$3,064.27
|
| Rate for Payer: HFN Commercial |
$3,167.56
|
| Rate for Payer: Multiplan Commercial |
$2,754.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,065.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,167.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,687.07
|
| Rate for Payer: Quartz Commercial |
$2,065.80
|
| Rate for Payer: WEA Trust Commercial |
$1,893.65
|
| Rate for Payer: WPS Commercial |
$2,550.23
|
|
|
CATHETER TRAY 12FR DUAL LUMAN 0600620
|
Facility
OP
|
$3,443.00
|
|
| Hospital Charge Code |
2963100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$964.04 |
| Max. Negotiated Rate |
$13,772.00 |
| Rate for Payer: Aetna Commercial |
$3,098.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,960.98
|
| Rate for Payer: Aetna Managed Medicare |
$964.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,237.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,721.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,652.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,824.79
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cigna Commercial |
$3,167.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,926.70
|
| Rate for Payer: Health EOS Commercial |
$3,064.27
|
| Rate for Payer: HFN Commercial |
$3,167.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,582.25
|
| Rate for Payer: Multiplan Commercial |
$2,754.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,065.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,167.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,687.07
|
| Rate for Payer: Quartz Commercial |
$2,237.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,065.80
|
| Rate for Payer: The Alliance Commercial |
$13,772.00
|
| Rate for Payer: WEA Trust Commercial |
$1,893.65
|
| Rate for Payer: WPS Commercial |
$2,550.23
|
|
|
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 |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
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 |
$72.24 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CATHETER URETERAL ADAPTER 140000
|
Facility
IP
|
$22.00
|
|
| Hospital Charge Code |
2963898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
CATHETER URETERAL ADAPTER 140000
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
2963898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.31
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
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 |
$346.08 |
| Max. Negotiated Rate |
$1,137.12 |
| Rate for Payer: Aetna Commercial |
$1,112.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.96
|
| Rate for Payer: Aetna Managed Medicare |
$346.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.08
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,137.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.67
|
| Rate for Payer: Health EOS Commercial |
$1,100.04
|
| Rate for Payer: HFN Commercial |
$1,137.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.00
|
| Rate for Payer: Multiplan Commercial |
$988.80
|
| Rate for Payer: NAPHCARE Commercial |
$741.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,137.12
|
| Rate for Payer: Quartz Beloit One Network |
$605.64
|
| Rate for Payer: Quartz Commercial |
$803.40
|
| Rate for Payer: Quartz Medicare Advantage |
$741.60
|
| Rate for Payer: WEA Trust Commercial |
$679.80
|
| Rate for Payer: WPS Commercial |
$915.51
|
|
|
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 |
$605.64 |
| Max. Negotiated Rate |
$1,137.12 |
| Rate for Payer: Aetna Commercial |
$1,112.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.08
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,137.12
|
| Rate for Payer: Health EOS Commercial |
$1,100.04
|
| Rate for Payer: HFN Commercial |
$1,137.12
|
| Rate for Payer: Multiplan Commercial |
$988.80
|
| Rate for Payer: NAPHCARE Commercial |
$741.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,137.12
|
| Rate for Payer: Quartz Beloit One Network |
$605.64
|
| Rate for Payer: Quartz Commercial |
$741.60
|
| Rate for Payer: WEA Trust Commercial |
$679.80
|
| Rate for Payer: WPS Commercial |
$915.51
|
|
|
CATHETER URETERAL DUAL LUMEN 405-100
|
Facility
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2964806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$6,460.00 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.75
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.25
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$1,049.75
|
| Rate for Payer: Quartz Medicare Advantage |
$969.00
|
| Rate for Payer: The Alliance Commercial |
$6,460.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
