|
KIT BIOPSY MISSION 18GX10CM 1810MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5458892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 18GX16CM 1816MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5458893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 18GX16CM 1816MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5458893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 18GX20CM 1820MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5458894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 18GX20CM 1820MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5458894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 20GX10CM 2010MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5349542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 20GX10CM 2010MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5349542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 20GX16CM 2016MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5349543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 20GX16CM 2016MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5349543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 20GX20CM 2020MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5349544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIOPSY MISSION 20GX20CM 2020MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5349544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
KIT BIO-TENODESIS DISPOSABLE AR-1676DS
|
Facility
|
IP
|
$4,270.00
|
|
| Hospital Charge Code |
2964685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,092.30 |
| Max. Negotiated Rate |
$3,928.40 |
| Rate for Payer: Aetna Commercial |
$3,843.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.10
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cigna Commercial |
$3,928.40
|
| Rate for Payer: Health EOS Commercial |
$3,800.30
|
| Rate for Payer: HFN Commercial |
$3,928.40
|
| Rate for Payer: Multiplan Commercial |
$3,416.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.30
|
| Rate for Payer: Quartz Commercial |
$2,562.00
|
| Rate for Payer: WEA Trust Commercial |
$2,348.50
|
| Rate for Payer: WPS Commercial |
$3,162.79
|
|
|
KIT BIO-TENODESIS DISPOSABLE AR-1676DS
|
Facility
|
OP
|
$4,270.00
|
|
| Hospital Charge Code |
2964685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$17,080.00 |
| Rate for Payer: Aetna Commercial |
$3,843.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,775.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,049.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.10
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cigna Commercial |
$3,928.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,389.49
|
| Rate for Payer: Health EOS Commercial |
$3,800.30
|
| Rate for Payer: HFN Commercial |
$3,928.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,416.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.30
|
| Rate for Payer: Quartz Commercial |
$2,775.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.00
|
| Rate for Payer: The Alliance Commercial |
$17,080.00
|
| Rate for Payer: WEA Trust Commercial |
$2,348.50
|
| Rate for Payer: WPS Commercial |
$3,162.79
|
|
|
KIT BONE HARVESTINE RIA 2 520MM STERILE 03.404.000S
|
Facility
|
OP
|
$13,175.00
|
|
| Hospital Charge Code |
6001634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,689.00 |
| Max. Negotiated Rate |
$52,700.00 |
| Rate for Payer: Aetna Commercial |
$11,857.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,330.50
|
| Rate for Payer: Aetna Managed Medicare |
$3,689.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,563.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,587.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,982.75
|
| Rate for Payer: Cash Price |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$12,121.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,372.73
|
| Rate for Payer: Health EOS Commercial |
$11,725.75
|
| Rate for Payer: HFN Commercial |
$12,121.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,881.25
|
| Rate for Payer: Multiplan Commercial |
$10,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,905.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,121.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,455.75
|
| Rate for Payer: Quartz Commercial |
$8,563.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,905.00
|
| Rate for Payer: The Alliance Commercial |
$52,700.00
|
| Rate for Payer: WEA Trust Commercial |
$7,246.25
|
| Rate for Payer: WPS Commercial |
$9,758.72
|
|
|
KIT BONE HARVESTINE RIA 2 520MM STERILE 03.404.000S
|
Facility
|
IP
|
$13,175.00
|
|
| Hospital Charge Code |
6001634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,455.75 |
| Max. Negotiated Rate |
$12,121.00 |
| Rate for Payer: Aetna Commercial |
$11,857.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,330.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,982.75
|
| Rate for Payer: Cash Price |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$12,121.00
|
| Rate for Payer: Health EOS Commercial |
$11,725.75
|
| Rate for Payer: HFN Commercial |
$12,121.00
|
| Rate for Payer: Multiplan Commercial |
$10,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,905.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,121.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,455.75
|
| Rate for Payer: Quartz Commercial |
$7,905.00
|
| Rate for Payer: WEA Trust Commercial |
$7,246.25
|
| Rate for Payer: WPS Commercial |
$9,758.72
|
|
|
KIT CATARACT FRIEDRICHS
|
Facility
|
IP
|
$6,953.00
|
|
| Hospital Charge Code |
5563688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,406.97 |
| Max. Negotiated Rate |
$6,396.76 |
| Rate for Payer: Aetna Commercial |
$6,257.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.09
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,396.76
|
| Rate for Payer: Health EOS Commercial |
$6,188.17
|
| Rate for Payer: HFN Commercial |
$6,396.76
|
| Rate for Payer: Multiplan Commercial |
$5,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,396.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,406.97
|
| Rate for Payer: Quartz Commercial |
$4,171.80
|
| Rate for Payer: WEA Trust Commercial |
$3,824.15
|
| Rate for Payer: WPS Commercial |
$5,150.09
|
|
|
KIT CATARACT FRIEDRICHS
|
Facility
|
OP
|
$6,953.00
|
|
| Hospital Charge Code |
5563688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,946.84 |
| Max. Negotiated Rate |
$27,812.00 |
| Rate for Payer: Aetna Commercial |
$6,257.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,946.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,519.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,337.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.09
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,396.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,890.90
|
| Rate for Payer: Health EOS Commercial |
$6,188.17
|
| Rate for Payer: HFN Commercial |
$6,396.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,214.75
|
| Rate for Payer: Multiplan Commercial |
$5,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,396.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,406.97
|
| Rate for Payer: Quartz Commercial |
$4,519.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,171.80
|
| Rate for Payer: The Alliance Commercial |
$27,812.00
|
| Rate for Payer: WEA Trust Commercial |
$3,824.15
|
| Rate for Payer: WPS Commercial |
$5,150.09
|
|
|
KIT CATARACT ROJAS
|
Facility
|
OP
|
$4,501.00
|
|
| Hospital Charge Code |
5563687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.28 |
| Max. Negotiated Rate |
$18,004.00 |
| Rate for Payer: Aetna Commercial |
$4,050.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,870.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,260.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,925.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,160.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,385.53
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Cigna Commercial |
$4,140.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,518.76
|
| Rate for Payer: Health EOS Commercial |
$4,005.89
|
| Rate for Payer: HFN Commercial |
$4,140.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,375.75
|
| Rate for Payer: Multiplan Commercial |
$3,600.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,700.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,140.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,205.49
|
| Rate for Payer: Quartz Commercial |
$2,925.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,700.60
|
| Rate for Payer: The Alliance Commercial |
$18,004.00
|
| Rate for Payer: WEA Trust Commercial |
$2,475.55
|
| Rate for Payer: WPS Commercial |
$3,333.89
|
|
|
KIT CATARACT ROJAS
|
Facility
|
IP
|
$4,501.00
|
|
| Hospital Charge Code |
5563687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,205.49 |
| Max. Negotiated Rate |
$4,140.92 |
| Rate for Payer: Aetna Commercial |
$4,050.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,870.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,385.53
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Cigna Commercial |
$4,140.92
|
| Rate for Payer: Health EOS Commercial |
$4,005.89
|
| Rate for Payer: HFN Commercial |
$4,140.92
|
| Rate for Payer: Multiplan Commercial |
$3,600.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,700.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,140.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,205.49
|
| Rate for Payer: Quartz Commercial |
$2,700.60
|
| Rate for Payer: WEA Trust Commercial |
$2,475.55
|
| Rate for Payer: WPS Commercial |
$3,333.89
|
|
|
KIT CATARACT TOWNSHEND
|
Facility
|
IP
|
$4,175.00
|
|
| Hospital Charge Code |
5563686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,045.75 |
| Max. Negotiated Rate |
$3,841.00 |
| Rate for Payer: Aetna Commercial |
$3,757.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.75
|
| Rate for Payer: Cash Price |
$1,252.50
|
| Rate for Payer: Cigna Commercial |
$3,841.00
|
| Rate for Payer: Health EOS Commercial |
$3,715.75
|
| Rate for Payer: HFN Commercial |
$3,841.00
|
| Rate for Payer: Multiplan Commercial |
$3,340.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,505.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,841.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.75
|
| Rate for Payer: Quartz Commercial |
$2,505.00
|
| Rate for Payer: WEA Trust Commercial |
$2,296.25
|
| Rate for Payer: WPS Commercial |
$3,092.42
|
|
|
KIT CATARACT TOWNSHEND
|
Facility
|
OP
|
$4,175.00
|
|
| Hospital Charge Code |
5563686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,169.00 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: Aetna Commercial |
$3,757.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,169.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,713.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,087.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,004.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.75
|
| Rate for Payer: Cash Price |
$1,252.50
|
| Rate for Payer: Cigna Commercial |
$3,841.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,336.33
|
| Rate for Payer: Health EOS Commercial |
$3,715.75
|
| Rate for Payer: HFN Commercial |
$3,841.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,131.25
|
| Rate for Payer: Multiplan Commercial |
$3,340.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,505.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,841.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.75
|
| Rate for Payer: Quartz Commercial |
$2,713.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,505.00
|
| Rate for Payer: The Alliance Commercial |
$16,700.00
|
| Rate for Payer: WEA Trust Commercial |
$2,296.25
|
| Rate for Payer: WPS Commercial |
$3,092.42
|
|
|
KIT CATHETER 3MM LACRICATH AQL 1015 ATRION QL1015 DCP315-UNIT
|
Facility
|
OP
|
$3,735.00
|
|
| Hospital Charge Code |
2965940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,045.80 |
| Max. Negotiated Rate |
$14,940.00 |
| Rate for Payer: Aetna Commercial |
$3,361.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,045.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,427.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,867.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,792.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,979.55
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,436.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,090.11
|
| Rate for Payer: Health EOS Commercial |
$3,324.15
|
| Rate for Payer: HFN Commercial |
$3,436.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,801.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,436.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.15
|
| Rate for Payer: Quartz Commercial |
$2,427.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,241.00
|
| Rate for Payer: The Alliance Commercial |
$14,940.00
|
| Rate for Payer: WEA Trust Commercial |
$2,054.25
|
| Rate for Payer: WPS Commercial |
$2,766.51
|
|
|
KIT CATHETER 3MM LACRICATH AQL 1015 ATRION QL1015 DCP315-UNIT
|
Facility
|
IP
|
$3,735.00
|
|
| Hospital Charge Code |
2965940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,830.15 |
| Max. Negotiated Rate |
$3,436.20 |
| Rate for Payer: Aetna Commercial |
$3,361.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,979.55
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,436.20
|
| Rate for Payer: Health EOS Commercial |
$3,324.15
|
| Rate for Payer: HFN Commercial |
$3,436.20
|
| Rate for Payer: Multiplan Commercial |
$2,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,436.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.15
|
| Rate for Payer: Quartz Commercial |
$2,241.00
|
| Rate for Payer: WEA Trust Commercial |
$2,054.25
|
| Rate for Payer: WPS Commercial |
$2,766.51
|
|
|
KIT CATHETER PED/INFANT 5 FR
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2963308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
KIT CATHETER PED/INFANT 5 FR
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2963308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
