|
CATHETER EMBOLECTOMY 4FR A4548
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Aetna Managed Medicare |
$364.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$845.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$650.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$727.50
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$845.00
|
| Rate for Payer: Quartz Medicare Advantage |
$780.00
|
| Rate for Payer: The Alliance Commercial |
$650.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
CATHETER EMBOLECTOMY 4FR A4548
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$780.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
CATHETER EMMETT 26FR 30CC 3-WAY 0138L26
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
5414944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
CATHETER EMMETT 26FR 30CC 3-WAY 0138L26
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
5414944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
CATHETER EPISTAXIS 20-10701
|
Facility
|
OP
|
$986.00
|
|
| Hospital Charge Code |
2963459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.12 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Aetna Managed Medicare |
$287.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.85
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$769.08
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: NAPHCARE Commercial |
$615.26
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$666.54
|
| Rate for Payer: Quartz Medicare Advantage |
$615.26
|
| Rate for Payer: The Alliance Commercial |
$512.72
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
|
CATHETER EPISTAXIS 20-10701
|
Facility
|
IP
|
$986.00
|
|
| Hospital Charge Code |
2963459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.47 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$615.26
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
|
CATHETER ERCP
|
Facility
|
IP
|
$1,138.00
|
|
| Hospital Charge Code |
2963461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$710.11
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
CATHETER ERCP
|
Facility
|
OP
|
$1,138.00
|
|
| Hospital Charge Code |
2963461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.39 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Aetna Managed Medicare |
$331.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.32
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.64
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: NAPHCARE Commercial |
$710.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$769.29
|
| Rate for Payer: Quartz Medicare Advantage |
$710.11
|
| Rate for Payer: The Alliance Commercial |
$591.76
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
CATHETER EXCHANGE, DIALYSIS
|
Facility
|
IP
|
$1,872.00
|
|
| Hospital Charge Code |
6209793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$953.97 |
| Max. Negotiated Rate |
$1,791.13 |
| Rate for Payer: Aetna Commercial |
$1,752.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.85
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,791.13
|
| Rate for Payer: Health EOS Commercial |
$1,732.72
|
| Rate for Payer: HFN Commercial |
$1,791.13
|
| Rate for Payer: Multiplan Commercial |
$1,557.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.13
|
| Rate for Payer: Quartz Beloit One Network |
$953.97
|
| Rate for Payer: Quartz Commercial |
$1,168.13
|
| Rate for Payer: WEA Trust Commercial |
$1,070.78
|
| Rate for Payer: WPS Commercial |
$1,442.00
|
|
|
CATHETER EXCHANGE, DIALYSIS
|
Facility
|
OP
|
$1,872.00
|
|
| Hospital Charge Code |
6209793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$545.13 |
| Max. Negotiated Rate |
$1,791.13 |
| Rate for Payer: Aetna Commercial |
$1,752.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.32
|
| Rate for Payer: Aetna Managed Medicare |
$545.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.85
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,791.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.50
|
| Rate for Payer: Health EOS Commercial |
$1,732.72
|
| Rate for Payer: HFN Commercial |
$1,791.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.16
|
| Rate for Payer: Multiplan Commercial |
$1,557.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.13
|
| Rate for Payer: Quartz Beloit One Network |
$953.97
|
| Rate for Payer: Quartz Commercial |
$1,265.47
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.13
|
| Rate for Payer: The Alliance Commercial |
$973.44
|
| Rate for Payer: WEA Trust Commercial |
$1,070.78
|
| Rate for Payer: WPS Commercial |
$1,442.00
|
|
|
CATHETER FOLEY 10FR 3cc I.C 0165SI10
|
Facility
|
IP
|
$263.00
|
|
| Hospital Charge Code |
2963280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$164.11
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
CATHETER FOLEY 10FR 3cc I.C 0165SI10
|
Facility
|
OP
|
$263.00
|
|
| Hospital Charge Code |
2963280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$76.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.07
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$164.11
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$177.79
|
| Rate for Payer: Quartz Medicare Advantage |
$164.11
|
| Rate for Payer: The Alliance Commercial |
$136.76
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
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 |
$48.92 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$72.72
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
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 |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
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 |
$94.89 |
| Max. Negotiated Rate |
$775.01 |
| Rate for Payer: Aetna Commercial |
$758.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.46
|
| Rate for Payer: Aetna Managed Medicare |
$235.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.47
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$775.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.42
|
| Rate for Payer: Health EOS Commercial |
$749.74
|
| Rate for Payer: HFN Commercial |
$775.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$631.80
|
| Rate for Payer: Multiplan Commercial |
$673.92
|
| Rate for Payer: NAPHCARE Commercial |
$505.44
|
| Rate for Payer: Preferred Network Access Commercial |
$775.01
|
| Rate for Payer: Quartz Beloit One Network |
$412.78
|
| Rate for Payer: Quartz Commercial |
$547.56
|
| Rate for Payer: Quartz Medicare Advantage |
$505.44
|
| Rate for Payer: The Alliance Commercial |
$94.89
|
| Rate for Payer: WEA Trust Commercial |
$463.32
|
| Rate for Payer: WPS Commercial |
$623.94
|
|
|
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 |
$412.78 |
| Max. Negotiated Rate |
$775.01 |
| Rate for Payer: Aetna Commercial |
$758.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.47
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$775.01
|
| Rate for Payer: Health EOS Commercial |
$749.74
|
| Rate for Payer: HFN Commercial |
$775.01
|
| Rate for Payer: Multiplan Commercial |
$673.92
|
| Rate for Payer: Preferred Network Access Commercial |
$775.01
|
| Rate for Payer: Quartz Beloit One Network |
$412.78
|
| Rate for Payer: Quartz Commercial |
$505.44
|
| Rate for Payer: WEA Trust Commercial |
$463.32
|
| Rate for Payer: WPS Commercial |
$623.94
|
|
|
CATHETER FOLEY 14FR 10ML 2-WAY 100% SILICONE DYND11501
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
6175436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.74
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$51.79
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$51.79
|
| Rate for Payer: The Alliance Commercial |
$43.16
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
CATHETER FOLEY 14FR 10ML 2-WAY 100% SILICONE DYND11501
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
6175436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
CATHETER FOLEY 14FR 30CC 0166SI14
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
2963233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
CATHETER FOLEY 14FR 30CC 0166SI14
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
2963233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.44
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26.21
|
| Rate for Payer: The Alliance Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
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 |
$154.04 |
| Max. Negotiated Rate |
$506.15 |
| Rate for Payer: Aetna Commercial |
$495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Aetna Managed Medicare |
$154.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.58
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$506.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.88
|
| Rate for Payer: Health EOS Commercial |
$489.64
|
| Rate for Payer: HFN Commercial |
$506.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.62
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: NAPHCARE Commercial |
$330.10
|
| Rate for Payer: Preferred Network Access Commercial |
$506.15
|
| Rate for Payer: Quartz Beloit One Network |
$269.58
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: Quartz Medicare Advantage |
$330.10
|
| Rate for Payer: The Alliance Commercial |
$188.24
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
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 |
$269.58 |
| Max. Negotiated Rate |
$506.15 |
| Rate for Payer: Aetna Commercial |
$495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.58
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$506.15
|
| Rate for Payer: Health EOS Commercial |
$489.64
|
| Rate for Payer: HFN Commercial |
$506.15
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: Preferred Network Access Commercial |
$506.15
|
| Rate for Payer: Quartz Beloit One Network |
$269.58
|
| Rate for Payer: Quartz Commercial |
$330.10
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
CATHETER FOLEY 14FR 5CC 2-WAY LATEX 0165SI14
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
2963279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$47.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$101.71
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$101.71
|
| Rate for Payer: The Alliance Commercial |
$84.76
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
CATHETER FOLEY 14FR 5CC 2-WAY LATEX 0165SI14
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
2963279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
CATHETER FOLEY 16FR 10CC 2-WAY COUDE RUSCH 318116
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS A4353
|
| Hospital Charge Code |
2963368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$57.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$101.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.07
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$132.50
|
| Rate for Payer: Quartz Medicare Advantage |
$122.30
|
| Rate for Payer: The Alliance Commercial |
$41.56
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
