|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$80,195.00
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$28,847.22 |
| Max. Negotiated Rate |
$80,195.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,847.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,940.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,834.00
|
| Rate for Payer: Anthem Medicare Advantage |
$28,847.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,847.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,847.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,847.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,879.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,847.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,585.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,847.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,847.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,847.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,847.22
|
| Rate for Payer: NAPHCARE Commercial |
$43,270.83
|
| Rate for Payer: Quartz Medicare Advantage |
$28,847.22
|
| Rate for Payer: The Alliance Commercial |
$80,195.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,847.22
|
| Rate for Payer: Wellcare Medicare |
$28,847.22
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$119,891.00
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$43,126.18 |
| Max. Negotiated Rate |
$119,891.00 |
| Rate for Payer: Aetna Managed Medicare |
$43,126.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94,410.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72,364.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68,751.00
|
| Rate for Payer: Anthem Medicare Advantage |
$43,126.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,126.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,126.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,126.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76,319.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,126.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87,701.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,126.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,126.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,126.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,126.18
|
| Rate for Payer: NAPHCARE Commercial |
$64,689.27
|
| Rate for Payer: Quartz Medicare Advantage |
$43,126.18
|
| Rate for Payer: The Alliance Commercial |
$119,891.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,126.18
|
| Rate for Payer: United Healthcare PPO |
$68,276.55
|
| Rate for Payer: Wellcare Medicare |
$43,126.18
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$92,265.00
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$33,188.97 |
| Max. Negotiated Rate |
$92,265.00 |
| Rate for Payer: Aetna Managed Medicare |
$33,188.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72,590.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55,640.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52,861.88
|
| Rate for Payer: Anthem Medicare Advantage |
$33,188.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,188.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,188.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,188.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58,681.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,188.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67,438.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,188.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,188.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,188.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,188.97
|
| Rate for Payer: NAPHCARE Commercial |
$49,783.46
|
| Rate for Payer: Quartz Medicare Advantage |
$33,188.97
|
| Rate for Payer: The Alliance Commercial |
$92,265.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,188.97
|
| Rate for Payer: United Healthcare PPO |
$52,501.97
|
| Rate for Payer: Wellcare Medicare |
$33,188.97
|
|
|
KINESIO GOLD TEX TAPE - BLACK 081605120
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971981
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$74.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$1,064.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
KINESIO GOLD TEX TAPE - BLACK 081605120
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971981
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
KINESIO GOLD TEX TAPE - BLUE 081605278
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
KINESIO GOLD TEX TAPE - BLUE 081605278
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$74.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$1,064.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
KINESIO GOLD TEX TAPE - RED # A840241
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971983
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
KINESIO GOLD TEX TAPE - RED # A840241
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971983
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$74.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$1,064.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
KINESIOTAPE BEIGE 5cm x31.5 BULK 0816-05-146
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
2969774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$472.36 |
| Max. Negotiated Rate |
$886.88 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$578.40
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
KINESIOTAPE BEIGE 5cm x31.5 BULK 0816-05-146
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
2969774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$269.92 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Aetna Managed Medicare |
$269.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$626.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$482.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.45
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.00
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$626.60
|
| Rate for Payer: Quartz Medicare Advantage |
$578.40
|
| Rate for Payer: The Alliance Commercial |
$3,856.00
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
KIT 3.0 SUTURETAK DISP INSTR AR-8934DSC
|
Facility
|
OP
|
$1,802.00
|
|
| Hospital Charge Code |
6217008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.56 |
| Max. Negotiated Rate |
$7,208.00 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Aetna Managed Medicare |
$504.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,171.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$901.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$864.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.06
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,657.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,008.40
|
| Rate for Payer: Health EOS Commercial |
$1,603.78
|
| Rate for Payer: HFN Commercial |
$1,657.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.50
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,081.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,657.84
|
| Rate for Payer: Quartz Beloit One Network |
$882.98
|
| Rate for Payer: Quartz Commercial |
$1,171.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,081.20
|
| Rate for Payer: The Alliance Commercial |
$7,208.00
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
KIT 3.0 SUTURETAK DISP INSTR AR-8934DSC
|
Facility
|
IP
|
$1,802.00
|
|
| Hospital Charge Code |
6217008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.98 |
| Max. Negotiated Rate |
$1,657.84 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.06
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,657.84
|
| Rate for Payer: Health EOS Commercial |
$1,603.78
|
| Rate for Payer: HFN Commercial |
$1,657.84
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,081.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,657.84
|
| Rate for Payer: Quartz Beloit One Network |
$882.98
|
| Rate for Payer: Quartz Commercial |
$1,081.20
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
KIT 5MS DISP INSTRUMENT SINGLE USE P06 S0001
|
Facility
|
IP
|
$3,990.00
|
|
| Hospital Charge Code |
6172203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,955.10 |
| Max. Negotiated Rate |
$3,670.80 |
| Rate for Payer: Aetna Commercial |
$3,591.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,431.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.70
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$3,670.80
|
| Rate for Payer: Health EOS Commercial |
$3,551.10
|
| Rate for Payer: HFN Commercial |
$3,670.80
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,394.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,670.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,955.10
|
| Rate for Payer: Quartz Commercial |
$2,394.00
|
| Rate for Payer: WEA Trust Commercial |
$2,194.50
|
| Rate for Payer: WPS Commercial |
$2,955.39
|
|
|
KIT 5MS DISP INSTRUMENT SINGLE USE P06 S0001
|
Facility
|
OP
|
$3,990.00
|
|
| Hospital Charge Code |
6172203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,117.20 |
| Max. Negotiated Rate |
$15,960.00 |
| Rate for Payer: Aetna Commercial |
$3,591.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,431.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,117.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,593.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,995.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,915.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.70
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$3,670.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,232.80
|
| Rate for Payer: Health EOS Commercial |
$3,551.10
|
| Rate for Payer: HFN Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,992.50
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,394.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,670.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,955.10
|
| Rate for Payer: Quartz Commercial |
$2,593.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,394.00
|
| Rate for Payer: The Alliance Commercial |
$15,960.00
|
| Rate for Payer: WEA Trust Commercial |
$2,194.50
|
| Rate for Payer: WPS Commercial |
$2,955.39
|
|
|
KIT 7.5 40cc IAB
|
Facility
|
IP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,312.00 |
| Max. Negotiated Rate |
$8,096.00 |
| Rate for Payer: Aetna Commercial |
$7,920.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,568.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,664.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,096.00
|
| Rate for Payer: Health EOS Commercial |
$7,832.00
|
| Rate for Payer: HFN Commercial |
$8,096.00
|
| Rate for Payer: Multiplan Commercial |
$7,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,096.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,312.00
|
| Rate for Payer: Quartz Commercial |
$5,280.00
|
| Rate for Payer: WEA Trust Commercial |
$4,840.00
|
| Rate for Payer: WPS Commercial |
$6,518.16
|
|
|
KIT 7.5 40cc IAB
|
Facility
|
OP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,464.00 |
| Max. Negotiated Rate |
$35,200.00 |
| Rate for Payer: Aetna Commercial |
$7,920.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,568.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,464.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,720.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,224.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,664.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,096.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,924.48
|
| Rate for Payer: Health EOS Commercial |
$7,832.00
|
| Rate for Payer: HFN Commercial |
$8,096.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,600.00
|
| Rate for Payer: Multiplan Commercial |
$7,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,096.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,312.00
|
| Rate for Payer: Quartz Commercial |
$5,720.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,280.00
|
| Rate for Payer: The Alliance Commercial |
$35,200.00
|
| Rate for Payer: WEA Trust Commercial |
$4,840.00
|
| Rate for Payer: WPS Commercial |
$6,518.16
|
|
|
KIT ABLATION DISPOSIBLE ESTECH
|
Facility
|
OP
|
$15,253.00
|
|
| Hospital Charge Code |
2965112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,270.84 |
| Max. Negotiated Rate |
$61,012.00 |
| Rate for Payer: Aetna Commercial |
$13,727.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,117.58
|
| Rate for Payer: Aetna Managed Medicare |
$4,270.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,914.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,626.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,321.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,084.09
|
| Rate for Payer: Cash Price |
$4,575.90
|
| Rate for Payer: Cigna Commercial |
$14,032.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,535.58
|
| Rate for Payer: Health EOS Commercial |
$13,575.17
|
| Rate for Payer: HFN Commercial |
$14,032.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,439.75
|
| Rate for Payer: Multiplan Commercial |
$12,202.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,151.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,032.76
|
| Rate for Payer: Quartz Beloit One Network |
$7,473.97
|
| Rate for Payer: Quartz Commercial |
$9,914.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,151.80
|
| Rate for Payer: The Alliance Commercial |
$61,012.00
|
| Rate for Payer: WEA Trust Commercial |
$8,389.15
|
| Rate for Payer: WPS Commercial |
$11,297.90
|
|
|
KIT ABLATION DISPOSIBLE ESTECH
|
Facility
|
IP
|
$15,253.00
|
|
| Hospital Charge Code |
2965112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,473.97 |
| Max. Negotiated Rate |
$14,032.76 |
| Rate for Payer: Aetna Commercial |
$13,727.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,117.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,084.09
|
| Rate for Payer: Cash Price |
$4,575.90
|
| Rate for Payer: Cigna Commercial |
$14,032.76
|
| Rate for Payer: Health EOS Commercial |
$13,575.17
|
| Rate for Payer: HFN Commercial |
$14,032.76
|
| Rate for Payer: Multiplan Commercial |
$12,202.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,151.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,032.76
|
| Rate for Payer: Quartz Beloit One Network |
$7,473.97
|
| Rate for Payer: Quartz Commercial |
$9,151.80
|
| Rate for Payer: WEA Trust Commercial |
$8,389.15
|
| Rate for Payer: WPS Commercial |
$11,297.90
|
|
|
KIT ACCELERATOR II FILTER/TUBING B5558-F
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
2965391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$287.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.59
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$666.25
|
| Rate for Payer: Quartz Medicare Advantage |
$615.00
|
| Rate for Payer: The Alliance Commercial |
$4,100.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
KIT ACCELERATOR II FILTER/TUBING B5558-F
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
2965391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$943.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$615.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
KIT ACCESS PORT VG & APS
|
Facility
|
IP
|
$5,903.00
|
|
| Hospital Charge Code |
2964637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,892.47 |
| Max. Negotiated Rate |
$5,430.76 |
| Rate for Payer: Aetna Commercial |
$5,312.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,076.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,128.59
|
| Rate for Payer: Cash Price |
$1,770.90
|
| Rate for Payer: Cigna Commercial |
$5,430.76
|
| Rate for Payer: Health EOS Commercial |
$5,253.67
|
| Rate for Payer: HFN Commercial |
$5,430.76
|
| Rate for Payer: Multiplan Commercial |
$4,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,541.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,430.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,892.47
|
| Rate for Payer: Quartz Commercial |
$3,541.80
|
| Rate for Payer: WEA Trust Commercial |
$3,246.65
|
| Rate for Payer: WPS Commercial |
$4,372.35
|
|
|
KIT ACCESS PORT VG & APS
|
Facility
|
OP
|
$5,903.00
|
|
| Hospital Charge Code |
2964637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,652.84 |
| Max. Negotiated Rate |
$23,612.00 |
| Rate for Payer: Aetna Commercial |
$5,312.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,076.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,652.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,836.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,951.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,833.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,128.59
|
| Rate for Payer: Cash Price |
$1,770.90
|
| Rate for Payer: Cigna Commercial |
$5,430.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,303.32
|
| Rate for Payer: Health EOS Commercial |
$5,253.67
|
| Rate for Payer: HFN Commercial |
$5,430.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,427.25
|
| Rate for Payer: Multiplan Commercial |
$4,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,541.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,430.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,892.47
|
| Rate for Payer: Quartz Commercial |
$3,836.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,541.80
|
| Rate for Payer: The Alliance Commercial |
$23,612.00
|
| Rate for Payer: WEA Trust Commercial |
$3,246.65
|
| Rate for Payer: WPS Commercial |
$4,372.35
|
|
|
KIT ACL DISPOSABLE 232400
|
Facility
|
IP
|
$6,041.00
|
|
| Hospital Charge Code |
3072461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,960.09 |
| Max. Negotiated Rate |
$5,557.72 |
| Rate for Payer: Aetna Commercial |
$5,436.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,195.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,201.73
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,557.72
|
| Rate for Payer: Health EOS Commercial |
$5,376.49
|
| Rate for Payer: HFN Commercial |
$5,557.72
|
| Rate for Payer: Multiplan Commercial |
$4,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,624.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,557.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,960.09
|
| Rate for Payer: Quartz Commercial |
$3,624.60
|
| Rate for Payer: WEA Trust Commercial |
$3,322.55
|
| Rate for Payer: WPS Commercial |
$4,474.57
|
|
|
KIT ACL DISPOSABLE 232400
|
Facility
|
OP
|
$6,041.00
|
|
| Hospital Charge Code |
3072461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,691.48 |
| Max. Negotiated Rate |
$24,164.00 |
| Rate for Payer: Aetna Commercial |
$5,436.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,195.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,691.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,926.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,020.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,899.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,201.73
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,557.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,380.54
|
| Rate for Payer: Health EOS Commercial |
$5,376.49
|
| Rate for Payer: HFN Commercial |
$5,557.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,530.75
|
| Rate for Payer: Multiplan Commercial |
$4,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,624.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,557.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,960.09
|
| Rate for Payer: Quartz Commercial |
$3,926.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,624.60
|
| Rate for Payer: The Alliance Commercial |
$24,164.00
|
| Rate for Payer: WEA Trust Commercial |
$3,322.55
|
| Rate for Payer: WPS Commercial |
$4,474.57
|
|
