|
CATHETER SUCTION KIT 14 FR 21 4864T
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2968887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
CATHETER SUCTION KIT 14 FR 21 4864T
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2968887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
CATHETER SUCTION KIT 5 FR 4863T
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2969219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
CATHETER SUCTION KIT 5 FR 4863T
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2969219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$51.17
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$51.17
|
| Rate for Payer: The Alliance Commercial |
$42.64
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
CATHETER SUCTION KIT 8 FR 4867T
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
2963486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
CATHETER SUCTION KIT 8 FR 4867T
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
2963486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
CATHETER SUPER-KIT MULTI LUMEN #AK-42703-SK
|
Facility
|
IP
|
$1,278.00
|
|
| Hospital Charge Code |
2973498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$1,222.79 |
| Rate for Payer: Aetna Commercial |
$1,196.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.43
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,222.79
|
| Rate for Payer: Health EOS Commercial |
$1,182.92
|
| Rate for Payer: HFN Commercial |
$1,222.79
|
| Rate for Payer: Multiplan Commercial |
$1,063.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.79
|
| Rate for Payer: Quartz Beloit One Network |
$651.27
|
| Rate for Payer: Quartz Commercial |
$797.47
|
| Rate for Payer: WEA Trust Commercial |
$731.02
|
| Rate for Payer: WPS Commercial |
$984.44
|
|
|
CATHETER SUPER-KIT MULTI LUMEN #AK-42703-SK
|
Facility
|
OP
|
$1,278.00
|
|
| Hospital Charge Code |
2973498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.15 |
| Max. Negotiated Rate |
$1,222.79 |
| Rate for Payer: Aetna Commercial |
$1,196.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.04
|
| Rate for Payer: Aetna Managed Medicare |
$372.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$863.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$664.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$637.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.43
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,222.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.80
|
| Rate for Payer: Health EOS Commercial |
$1,182.92
|
| Rate for Payer: HFN Commercial |
$1,222.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.84
|
| Rate for Payer: Multiplan Commercial |
$1,063.30
|
| Rate for Payer: NAPHCARE Commercial |
$797.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.79
|
| Rate for Payer: Quartz Beloit One Network |
$651.27
|
| Rate for Payer: Quartz Commercial |
$863.93
|
| Rate for Payer: Quartz Medicare Advantage |
$797.47
|
| Rate for Payer: The Alliance Commercial |
$664.56
|
| Rate for Payer: WEA Trust Commercial |
$731.02
|
| Rate for Payer: WPS Commercial |
$984.44
|
|
|
CATHETER SUPRAPUBIC 14 X 25CM LOOP G30405
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2969489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.05 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Aetna Managed Medicare |
$306.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$710.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.68
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.78
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: NAPHCARE Commercial |
$655.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$710.48
|
| Rate for Payer: Quartz Medicare Advantage |
$655.82
|
| Rate for Payer: The Alliance Commercial |
$546.52
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
CATHETER SUPRAPUBIC 14 X 25CM LOOP G30405
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2969489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.59 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$655.82
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
CATHETER SUPRAPUBIC 16FR X 22CM RUTNER BALLOON G14920
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2965855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.99 |
| Max. Negotiated Rate |
$597.04 |
| Rate for Payer: Aetna Commercial |
$584.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.95
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$597.04
|
| Rate for Payer: Health EOS Commercial |
$577.57
|
| Rate for Payer: HFN Commercial |
$597.04
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: Preferred Network Access Commercial |
$597.04
|
| Rate for Payer: Quartz Beloit One Network |
$317.99
|
| Rate for Payer: Quartz Commercial |
$389.38
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$480.67
|
|
|
CATHETER SUPRAPUBIC 16FR X 22CM RUTNER BALLOON G14920
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
2965855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$597.04 |
| Rate for Payer: Aetna Commercial |
$584.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Aetna Managed Medicare |
$181.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.95
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$597.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.17
|
| Rate for Payer: Health EOS Commercial |
$577.57
|
| Rate for Payer: HFN Commercial |
$597.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$486.72
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: NAPHCARE Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$597.04
|
| Rate for Payer: Quartz Beloit One Network |
$317.99
|
| Rate for Payer: Quartz Commercial |
$421.82
|
| Rate for Payer: Quartz Medicare Advantage |
$389.38
|
| Rate for Payer: The Alliance Commercial |
$324.48
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$480.67
|
|
|
Catheter,Suprapubic,Cystoscopi C2627
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
4378659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
Catheter,Suprapubic,Cystoscopi C2627
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
4378659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
Catheter,Suprapubic,Cystoscopi C2627
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
4378659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
CATHETER SUPRAPUBIC S-CATH 12FR X 42CM 10CC BALLOON OPEN TIP WITH INTRODUCER SET 5753
|
Facility
|
IP
|
$2,154.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
6166005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,097.68 |
| Max. Negotiated Rate |
$2,060.95 |
| Rate for Payer: Aetna Commercial |
$2,016.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,926.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.28
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$2,060.95
|
| Rate for Payer: Health EOS Commercial |
$1,993.74
|
| Rate for Payer: HFN Commercial |
$2,060.95
|
| Rate for Payer: Multiplan Commercial |
$1,792.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,060.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.68
|
| Rate for Payer: Quartz Commercial |
$1,344.10
|
| Rate for Payer: WEA Trust Commercial |
$1,232.09
|
| Rate for Payer: WPS Commercial |
$1,659.23
|
|
|
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 |
$627.24 |
| Max. Negotiated Rate |
$2,060.95 |
| Rate for Payer: Aetna Commercial |
$2,016.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,926.54
|
| Rate for Payer: Aetna Managed Medicare |
$627.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,456.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,120.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,075.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.28
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$2,060.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,253.63
|
| Rate for Payer: Health EOS Commercial |
$1,993.74
|
| Rate for Payer: HFN Commercial |
$2,060.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,680.12
|
| Rate for Payer: Multiplan Commercial |
$1,792.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,344.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,060.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.68
|
| Rate for Payer: Quartz Commercial |
$1,456.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,344.10
|
| Rate for Payer: The Alliance Commercial |
$1,120.08
|
| Rate for Payer: WEA Trust Commercial |
$1,232.09
|
| Rate for Payer: WPS Commercial |
$1,659.23
|
|
|
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 |
$776.92 |
| Max. Negotiated Rate |
$2,552.74 |
| Rate for Payer: Aetna Commercial |
$2,497.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Aetna Managed Medicare |
$776.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,331.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.60
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,552.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,552.78
|
| Rate for Payer: Health EOS Commercial |
$2,469.50
|
| Rate for Payer: HFN Commercial |
$2,552.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,081.04
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,664.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,552.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.61
|
| Rate for Payer: Quartz Commercial |
$1,803.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,664.83
|
| Rate for Payer: The Alliance Commercial |
$1,387.36
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: WPS Commercial |
$2,055.16
|
|
|
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 |
$1,359.61 |
| Max. Negotiated Rate |
$2,552.74 |
| Rate for Payer: Aetna Commercial |
$2,497.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.60
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,552.74
|
| Rate for Payer: Health EOS Commercial |
$2,469.50
|
| Rate for Payer: HFN Commercial |
$2,552.74
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,552.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.61
|
| Rate for Payer: Quartz Commercial |
$1,664.83
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: WPS Commercial |
$2,055.16
|
|
|
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 |
$1,097.68 |
| Max. Negotiated Rate |
$2,060.95 |
| Rate for Payer: Aetna Commercial |
$2,016.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,926.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.28
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$2,060.95
|
| Rate for Payer: Health EOS Commercial |
$1,993.74
|
| Rate for Payer: HFN Commercial |
$2,060.95
|
| Rate for Payer: Multiplan Commercial |
$1,792.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,060.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.68
|
| Rate for Payer: Quartz Commercial |
$1,344.10
|
| Rate for Payer: WEA Trust Commercial |
$1,232.09
|
| Rate for Payer: WPS Commercial |
$1,659.23
|
|
|
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 |
$627.24 |
| Max. Negotiated Rate |
$2,060.95 |
| Rate for Payer: Aetna Commercial |
$2,016.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,926.54
|
| Rate for Payer: Aetna Managed Medicare |
$627.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,456.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,120.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,075.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.28
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$2,060.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,253.63
|
| Rate for Payer: Health EOS Commercial |
$1,993.74
|
| Rate for Payer: HFN Commercial |
$2,060.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,680.12
|
| Rate for Payer: Multiplan Commercial |
$1,792.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,344.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,060.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.68
|
| Rate for Payer: Quartz Commercial |
$1,456.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,344.10
|
| Rate for Payer: The Alliance Commercial |
$1,120.08
|
| Rate for Payer: WEA Trust Commercial |
$1,232.09
|
| Rate for Payer: WPS Commercial |
$1,659.23
|
|
|
CATHETER SUPRAPUBIC SOF-FLEX 14FR x 23CM G14934
|
Facility
|
IP
|
$1,051.00
|
|
| Hospital Charge Code |
2974020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.59 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$655.82
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
CATHETER SUPRAPUBIC SOF-FLEX 14FR x 23CM G14934
|
Facility
|
OP
|
$1,051.00
|
|
| Hospital Charge Code |
2974020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.05 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Aetna Managed Medicare |
$306.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$710.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.68
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.78
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: NAPHCARE Commercial |
$655.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$710.48
|
| Rate for Payer: Quartz Medicare Advantage |
$655.82
|
| Rate for Payer: The Alliance Commercial |
$546.52
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
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 |
$691.53 |
| Max. Negotiated Rate |
$1,298.38 |
| Rate for Payer: Aetna Commercial |
$1,270.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,213.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.98
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,298.38
|
| Rate for Payer: Health EOS Commercial |
$1,256.04
|
| Rate for Payer: HFN Commercial |
$1,298.38
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,298.38
|
| Rate for Payer: Quartz Beloit One Network |
$691.53
|
| Rate for Payer: Quartz Commercial |
$846.77
|
| Rate for Payer: WEA Trust Commercial |
$776.20
|
| Rate for Payer: WPS Commercial |
$1,045.30
|
|
|
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 |
$395.16 |
| Max. Negotiated Rate |
$1,298.38 |
| Rate for Payer: Aetna Commercial |
$1,270.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,213.70
|
| Rate for Payer: Aetna Managed Medicare |
$395.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$917.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$705.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$677.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.98
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,298.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$789.77
|
| Rate for Payer: Health EOS Commercial |
$1,256.04
|
| Rate for Payer: HFN Commercial |
$1,298.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,058.46
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: NAPHCARE Commercial |
$846.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,298.38
|
| Rate for Payer: Quartz Beloit One Network |
$691.53
|
| Rate for Payer: Quartz Commercial |
$917.33
|
| Rate for Payer: Quartz Medicare Advantage |
$846.77
|
| Rate for Payer: The Alliance Commercial |
$705.64
|
| Rate for Payer: WEA Trust Commercial |
$776.20
|
| Rate for Payer: WPS Commercial |
$1,045.30
|
|
