|
CATHETER 18FR FOLEY 10CC 2-WAY COUDE RUSCH 318118
|
Facility
|
OP
|
$196.00
|
|
| Hospital Charge Code |
2963367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$784.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
CATHETER 18FR FOLEY 10CC 2-WAY COUDE RUSCH 318118
|
Facility
|
IP
|
$196.00
|
|
| Hospital Charge Code |
2963367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
CATHETER 18FR FOLEY 5CC 2-WAY COUNCIL LATEX 0196L18
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.93 |
| Max. Negotiated Rate |
$420.44 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$274.20
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
CATHETER 18FR FOLEY 5CC 2-WAY COUNCIL LATEX 0196L18
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2963104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.96 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Aetna Managed Medicare |
$127.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.74
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.75
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$297.05
|
| Rate for Payer: Quartz Medicare Advantage |
$274.20
|
| Rate for Payer: The Alliance Commercial |
$1,828.00
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
CATHETER 18FR TIEMAN COUDE 010118
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
2963555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
CATHETER 18FR TIEMAN COUDE 010118
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
2963555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Aetna Managed Medicare |
$37.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.55
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$87.75
|
| Rate for Payer: Quartz Medicare Advantage |
$81.00
|
| Rate for Payer: The Alliance Commercial |
$540.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
CATHETER 20FR 30CC SILICONE-ELASTOMER COATED BRD0166L20
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2974600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
CATHETER 20FR 30CC SILICONE-ELASTOMER COATED BRD0166L20
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2974600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$32.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$69.60
|
| Rate for Payer: The Alliance Commercial |
$464.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
CATHETER 20FR CD TIP 010120
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2974585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
CATHETER 20FR CD TIP 010120
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2974585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
CATHETER 20FR FOLEY 10CC SILICONE LATEX FREE DYND11504
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS A4344
|
| Hospital Charge Code |
5415548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
CATHETER 20FR FOLEY 10CC SILICONE LATEX FREE DYND11504
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS A4344
|
| Hospital Charge Code |
5415548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$96.00
|
| Rate for Payer: The Alliance Commercial |
$640.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
CATHETER 20FR RED RUBBER LATEX 056120
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2974556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
CATHETER 20FR RED RUBBER LATEX 056120
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
2974556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
CATHETER 22FR 30CC 3WAY FOLEY
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
CATHETER 22FR 30CC 3WAY FOLEY
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$76.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$163.20
|
| Rate for Payer: The Alliance Commercial |
$1,088.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
CATHETER 24FR 30CC 3WAY FOLEY
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$76.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$163.20
|
| Rate for Payer: The Alliance Commercial |
$1,088.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
CATHETER 24FR 30CC 3WAY FOLEY
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
CATHETER 24FR FOLEY 30CC 3 WAY IRRIG 0167L24
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
CATHETER 24FR FOLEY 30CC 3 WAY IRRIG 0167L24
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.88 |
| Max. Negotiated Rate |
$1,084.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$75.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.65
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.25
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$162.60
|
| Rate for Payer: The Alliance Commercial |
$1,084.00
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
CATHETER 24FR THORACIC 14024
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
4081914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$1,108.00 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$77.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.01
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.75
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$166.20
|
| Rate for Payer: The Alliance Commercial |
$1,108.00
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
CATHETER 24FR THORACIC 14024
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
4081914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
CATHETER 24FR TIEMANN COUDE 010124
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2963537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
CATHETER 24FR TIEMANN COUDE 010124
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2963537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
CATHETER 2.5 x 20 #38959-2025
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
