|
CATHETER FOLEY 24FR 5CC 165824
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963584
|
|
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 24FR 5CC 2-WAY COUDE 0168L24
|
Facility
|
IP
|
$188.00
|
|
| Hospital Charge Code |
2963205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CATHETER FOLEY 24FR 5CC 2-WAY COUDE 0168L24
|
Facility
|
OP
|
$188.00
|
|
| Hospital Charge Code |
2963205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$54.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| Rate for Payer: Quartz Medicare Advantage |
$117.31
|
| Rate for Payer: The Alliance Commercial |
$97.76
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CATHETER FOLEY 24FR 75CC 3-WAY COUVELAIRE TIP SOFT SIMPLASTIC RUSCH 570624
|
Facility
|
OP
|
$497.00
|
|
| Hospital Charge Code |
2963013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.73 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$258.44
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
CATHETER FOLEY 24FR 75CC 3-WAY COUVELAIRE TIP SOFT SIMPLASTIC RUSCH 570624
|
Facility
|
IP
|
$497.00
|
|
| Hospital Charge Code |
2963013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
CATHETER FOLEY 24FR AA6C24
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
3065492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$72.80
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
CATHETER FOLEY 24FR AA6C24
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
3065492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
CATHETER FOLEY 26FR 30CC 0166SI26
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2963189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
CATHETER FOLEY 26FR 30CC 0166SI26
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2963189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
CATHETER FOLEY 26FR 30CC 3-WAY IRRIG 0167L26
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
CATHETER FOLEY 26FR 30CC 3-WAY IRRIG 0167L26
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.38
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$169.10
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$169.10
|
| Rate for Payer: The Alliance Commercial |
$115.27
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
CATHETER FOLEY 26FR 5CC 2-WAY BARDEX 0165SI26
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
2963215
|
|
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 26FR 5CC 2-WAY BARDEX 0165SI26
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
2963215
|
|
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 28FR 30CC 0166SI28
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2963234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
CATHETER FOLEY 28FR 30CC 0166SI28
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2963234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
CATHETER FOLEY 8FR 3cc I.C 0165SI08
|
Facility
|
IP
|
$263.00
|
|
| Hospital Charge Code |
2963281
|
|
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 8FR 3cc I.C 0165SI08
|
Facility
|
OP
|
$263.00
|
|
| Hospital Charge Code |
2963281
|
|
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 FOR HYSTEROGRAPHY 58340
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3015108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$920.82 |
| Rate for Payer: Aetna Commercial |
$920.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.58
|
| Rate for Payer: Aetna Managed Medicare |
$50.00
|
| Rate for Payer: Anthem Medicare Advantage |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.00
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$920.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.00
|
| Rate for Payer: Health EOS Commercial |
$882.04
|
| Rate for Payer: HFN Commercial |
$920.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$775.42
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.82
|
| Rate for Payer: Quartz Beloit One Network |
$426.48
|
| Rate for Payer: Quartz Commercial |
$552.49
|
| Rate for Payer: Quartz Medicare Advantage |
$50.00
|
| Rate for Payer: The Alliance Commercial |
$212.51
|
| Rate for Payer: United Healthcare Medicaid |
$116.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.00
|
| Rate for Payer: WEA Trust Commercial |
$533.10
|
| Rate for Payer: WPS Commercial |
$225.01
|
|
|
CATHETER GENERAL DRAINAGE 10FR X 45CM PERCUTANEOUS 14000808
|
Facility
|
IP
|
$2,302.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.10 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,436.45
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
CATHETER GENERAL DRAINAGE 10FR X 45CM PERCUTANEOUS 14000808
|
Facility
|
OP
|
$2,302.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5977640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.34 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Aetna Managed Medicare |
$670.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.76
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.56
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,556.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.45
|
| Rate for Payer: The Alliance Commercial |
$1,197.04
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
CATHETER GLO-TIP SPRAY
|
Facility
|
IP
|
$1,308.00
|
|
| Hospital Charge Code |
3065507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$1,251.49 |
| Rate for Payer: Aetna Commercial |
$1,224.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,169.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$720.97
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$1,251.49
|
| Rate for Payer: Health EOS Commercial |
$1,210.68
|
| Rate for Payer: HFN Commercial |
$1,251.49
|
| Rate for Payer: Multiplan Commercial |
$1,088.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,251.49
|
| Rate for Payer: Quartz Beloit One Network |
$666.56
|
| Rate for Payer: Quartz Commercial |
$816.19
|
| Rate for Payer: WEA Trust Commercial |
$748.18
|
| Rate for Payer: WPS Commercial |
$1,007.55
|
|
|
CATHETER GLO-TIP SPRAY
|
Facility
|
OP
|
$1,308.00
|
|
| Hospital Charge Code |
3065507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.89 |
| Max. Negotiated Rate |
$1,251.49 |
| Rate for Payer: Aetna Commercial |
$1,224.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,169.88
|
| Rate for Payer: Aetna Managed Medicare |
$380.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$652.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$720.97
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$1,251.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.26
|
| Rate for Payer: Health EOS Commercial |
$1,210.68
|
| Rate for Payer: HFN Commercial |
$1,251.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.24
|
| Rate for Payer: Multiplan Commercial |
$1,088.26
|
| Rate for Payer: NAPHCARE Commercial |
$816.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,251.49
|
| Rate for Payer: Quartz Beloit One Network |
$666.56
|
| Rate for Payer: Quartz Commercial |
$884.21
|
| Rate for Payer: Quartz Medicare Advantage |
$816.19
|
| Rate for Payer: The Alliance Commercial |
$680.16
|
| Rate for Payer: WEA Trust Commercial |
$748.18
|
| Rate for Payer: WPS Commercial |
$1,007.55
|
|
|
CATHETER GROSHONG 9.5 FR.DUAL
|
Facility
|
OP
|
$4,873.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.02 |
| Max. Negotiated Rate |
$4,662.49 |
| Rate for Payer: Aetna Commercial |
$4,561.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,358.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,419.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,294.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,533.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,432.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,686.00
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cigna Commercial |
$4,662.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,836.09
|
| Rate for Payer: Health EOS Commercial |
$4,510.45
|
| Rate for Payer: HFN Commercial |
$4,662.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,800.94
|
| Rate for Payer: Multiplan Commercial |
$4,054.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,040.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,662.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.28
|
| Rate for Payer: Quartz Commercial |
$3,294.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,040.75
|
| Rate for Payer: The Alliance Commercial |
$2,533.96
|
| Rate for Payer: WEA Trust Commercial |
$2,787.36
|
| Rate for Payer: WPS Commercial |
$3,753.67
|
|
|
CATHETER GROSHONG 9.5 FR.DUAL
|
Facility
|
IP
|
$4,873.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,483.28 |
| Max. Negotiated Rate |
$4,662.49 |
| Rate for Payer: Aetna Commercial |
$4,561.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,358.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,686.00
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cigna Commercial |
$4,662.49
|
| Rate for Payer: Health EOS Commercial |
$4,510.45
|
| Rate for Payer: HFN Commercial |
$4,662.49
|
| Rate for Payer: Multiplan Commercial |
$4,054.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,662.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.28
|
| Rate for Payer: Quartz Commercial |
$3,040.75
|
| Rate for Payer: WEA Trust Commercial |
$2,787.36
|
| Rate for Payer: WPS Commercial |
$3,753.67
|
|
|
CATHETER GUIDE
|
Facility
|
IP
|
$3,967.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,021.58 |
| Max. Negotiated Rate |
$3,795.63 |
| Rate for Payer: Aetna Commercial |
$3,713.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,548.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,186.61
|
| Rate for Payer: Cash Price |
$1,190.10
|
| Rate for Payer: Cigna Commercial |
$3,795.63
|
| Rate for Payer: Health EOS Commercial |
$3,671.86
|
| Rate for Payer: HFN Commercial |
$3,795.63
|
| Rate for Payer: Multiplan Commercial |
$3,300.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,795.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,021.58
|
| Rate for Payer: Quartz Commercial |
$2,475.41
|
| Rate for Payer: WEA Trust Commercial |
$2,269.12
|
| Rate for Payer: WPS Commercial |
$3,055.78
|
|
