|
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,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
|
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
|
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
|
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 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 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
|
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 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 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
|
|
|
CATHETER TEMPO 5FR RENAL DOUBLE A-2 450-589
|
Facility
|
OP
|
$451.00
|
|
| Hospital Charge Code |
2971154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Aetna Managed Medicare |
$131.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.59
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.48
|
| Rate for Payer: Health EOS Commercial |
$417.45
|
| Rate for Payer: HFN Commercial |
$431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.78
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: NAPHCARE Commercial |
$281.42
|
| Rate for Payer: Preferred Network Access Commercial |
$431.52
|
| Rate for Payer: Quartz Beloit One Network |
$229.83
|
| Rate for Payer: Quartz Commercial |
$304.88
|
| Rate for Payer: Quartz Medicare Advantage |
$281.42
|
| Rate for Payer: The Alliance Commercial |
$234.52
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
CATHETER TEMPO 5FR RENAL DOUBLE A-2 450-589
|
Facility
|
IP
|
$451.00
|
|
| Hospital Charge Code |
2971154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.83 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.59
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$431.52
|
| Rate for Payer: Health EOS Commercial |
$417.45
|
| Rate for Payer: HFN Commercial |
$431.52
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: Preferred Network Access Commercial |
$431.52
|
| Rate for Payer: Quartz Beloit One Network |
$229.83
|
| Rate for Payer: Quartz Commercial |
$281.42
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
CATHETER THORACIC 24 FR 14724****DISC
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
3779538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
CATHETER THORACIC 24 FR 14724****DISC
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
3779538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
Catheter Tip Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
979909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Catheter Tip Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
979909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.45
|
|
|
Catheter Tip Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
979909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
CATHETER TRAY 12FR DUAL LUMAN 0600620
|
Facility
|
OP
|
$3,443.00
|
|
| Hospital Charge Code |
2963100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,002.60 |
| Max. Negotiated Rate |
$3,294.26 |
| Rate for Payer: Aetna Commercial |
$3,222.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,079.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,002.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,327.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,790.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,718.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.78
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cigna Commercial |
$3,294.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,003.83
|
| Rate for Payer: Health EOS Commercial |
$3,186.84
|
| Rate for Payer: HFN Commercial |
$3,294.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,685.54
|
| Rate for Payer: Multiplan Commercial |
$2,864.58
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.43
|
| Rate for Payer: Preferred Network Access Commercial |
$3,294.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.55
|
| Rate for Payer: Quartz Commercial |
$2,327.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,148.43
|
| Rate for Payer: The Alliance Commercial |
$1,790.36
|
| Rate for Payer: WEA Trust Commercial |
$1,969.40
|
| Rate for Payer: WPS Commercial |
$2,652.14
|
|
|
CATHETER TRAY 12FR DUAL LUMAN 0600620
|
Facility
|
IP
|
$3,443.00
|
|
| Hospital Charge Code |
2963100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,754.55 |
| Max. Negotiated Rate |
$3,294.26 |
| Rate for Payer: HFN Commercial |
$3,294.26
|
| Rate for Payer: Aetna Commercial |
$3,222.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,079.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.78
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cigna Commercial |
$3,294.26
|
| Rate for Payer: Health EOS Commercial |
$3,186.84
|
| Rate for Payer: Multiplan Commercial |
$2,864.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,294.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.55
|
| Rate for Payer: Quartz Commercial |
$2,148.43
|
| Rate for Payer: WEA Trust Commercial |
$1,969.40
|
| Rate for Payer: WPS Commercial |
$2,652.14
|
|
|
CATHETER UMBILICAL ARTERY 5FR 8888160341
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
2963031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$80.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$171.60
|
| Rate for Payer: The Alliance Commercial |
$143.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
CATHETER UMBILICAL ARTERY 5FR 8888160341
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
2963031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
