|
KIT CATH MIDLINE 3F PROVENA LF S4153108BDP
|
Facility
|
OP
|
$2,492.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
5547424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.76 |
| Max. Negotiated Rate |
$9,968.00 |
| Rate for Payer: Aetna Commercial |
$2,242.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,143.12
|
| Rate for Payer: Aetna Managed Medicare |
$697.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,246.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.76
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$2,292.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.52
|
| Rate for Payer: Health EOS Commercial |
$2,217.88
|
| Rate for Payer: HFN Commercial |
$2,292.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,869.00
|
| Rate for Payer: Multiplan Commercial |
$1,993.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.08
|
| Rate for Payer: Quartz Commercial |
$1,619.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.20
|
| Rate for Payer: The Alliance Commercial |
$9,968.00
|
| Rate for Payer: WEA Trust Commercial |
$1,370.60
|
| Rate for Payer: WPS Commercial |
$1,845.82
|
|
|
KIT CATH MIDLINE 3F PROVENA LF S4153108BDP
|
Facility
|
IP
|
$2,492.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
5547424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,221.08 |
| Max. Negotiated Rate |
$2,292.64 |
| Rate for Payer: Aetna Commercial |
$2,242.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,143.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.76
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$2,292.64
|
| Rate for Payer: Health EOS Commercial |
$2,217.88
|
| Rate for Payer: HFN Commercial |
$2,292.64
|
| Rate for Payer: Multiplan Commercial |
$1,993.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.08
|
| Rate for Payer: Quartz Commercial |
$1,495.20
|
| Rate for Payer: WEA Trust Commercial |
$1,370.60
|
| Rate for Payer: WPS Commercial |
$1,845.82
|
|
|
KIT CAVITY DRAINAGE CATH PERCUTANEOUS AK-01601
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.24 |
| Max. Negotiated Rate |
$1,541.92 |
| Rate for Payer: Aetna Commercial |
$1,508.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,441.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$888.28
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$1,541.92
|
| Rate for Payer: Health EOS Commercial |
$1,491.64
|
| Rate for Payer: HFN Commercial |
$1,541.92
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,005.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,541.92
|
| Rate for Payer: Quartz Beloit One Network |
$821.24
|
| Rate for Payer: Quartz Commercial |
$1,005.60
|
| Rate for Payer: WEA Trust Commercial |
$921.80
|
| Rate for Payer: WPS Commercial |
$1,241.41
|
|
|
KIT CAVITY DRAINAGE CATH PERCUTANEOUS AK-01601
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.28 |
| Max. Negotiated Rate |
$6,704.00 |
| Rate for Payer: Aetna Commercial |
$1,508.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,441.36
|
| Rate for Payer: Aetna Managed Medicare |
$469.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,089.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$838.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$804.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$888.28
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$1,541.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$937.89
|
| Rate for Payer: Health EOS Commercial |
$1,491.64
|
| Rate for Payer: HFN Commercial |
$1,541.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,257.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,005.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,541.92
|
| Rate for Payer: Quartz Beloit One Network |
$821.24
|
| Rate for Payer: Quartz Commercial |
$1,089.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,005.60
|
| Rate for Payer: The Alliance Commercial |
$6,704.00
|
| Rate for Payer: WEA Trust Commercial |
$921.80
|
| Rate for Payer: WPS Commercial |
$1,241.41
|
|
|
KIT CENTURION ULTRASOUND FLUID MANAGEMENT 8065752201
|
Facility
|
IP
|
$343.00
|
|
| Hospital Charge Code |
5107100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.07 |
| Max. Negotiated Rate |
$315.56 |
| Rate for Payer: Aetna Commercial |
$308.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.79
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$315.56
|
| Rate for Payer: Health EOS Commercial |
$305.27
|
| Rate for Payer: HFN Commercial |
$315.56
|
| Rate for Payer: Multiplan Commercial |
$274.40
|
| Rate for Payer: NAPHCARE Commercial |
$205.80
|
| Rate for Payer: Preferred Network Access Commercial |
$315.56
|
| Rate for Payer: Quartz Beloit One Network |
$168.07
|
| Rate for Payer: Quartz Commercial |
$205.80
|
| Rate for Payer: WEA Trust Commercial |
$188.65
|
| Rate for Payer: WPS Commercial |
$254.06
|
|
|
KIT CENTURION ULTRASOUND FLUID MANAGEMENT 8065752201
|
Facility
|
OP
|
$343.00
|
|
| Hospital Charge Code |
5107100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna Commercial |
$308.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.98
|
| Rate for Payer: Aetna Managed Medicare |
$96.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.79
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$315.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.94
|
| Rate for Payer: Health EOS Commercial |
$305.27
|
| Rate for Payer: HFN Commercial |
$315.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$274.40
|
| Rate for Payer: NAPHCARE Commercial |
$205.80
|
| Rate for Payer: Preferred Network Access Commercial |
$315.56
|
| Rate for Payer: Quartz Beloit One Network |
$168.07
|
| Rate for Payer: Quartz Commercial |
$222.95
|
| Rate for Payer: Quartz Medicare Advantage |
$205.80
|
| Rate for Payer: The Alliance Commercial |
$1,372.00
|
| Rate for Payer: WEA Trust Commercial |
$188.65
|
| Rate for Payer: WPS Commercial |
$254.06
|
|
|
KIT CENTURION ULTRAVIT VITRECTOMY 8065752134
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
5107101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
KIT CENTURION ULTRAVIT VITRECTOMY 8065752134
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
5107101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
KIT CENT.VEN.CATH.FEM.ARTERY (MIN 5) EA C-PMS-301-FA***CUSTOM 6-8 WK LEAD TIME
|
Facility
|
OP
|
$543.00
|
|
| Hospital Charge Code |
2969242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.86
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
KIT CENT.VEN.CATH.FEM.ARTERY (MIN 5) EA C-PMS-301-FA***CUSTOM 6-8 WK LEAD TIME
|
Facility
|
IP
|
$543.00
|
|
| Hospital Charge Code |
2969242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
KIT CIRCUIT CPAP / O2 #RT324
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
2973589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
KIT CIRCUIT CPAP / O2 #RT324
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
2973589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 100CM WITH MICRO INTRODUCER SET CPK55-11
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
4399654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,445.80 |
| Max. Negotiated Rate |
$34,940.00 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,445.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,677.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,888.11
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,551.25
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,677.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,241.00
|
| Rate for Payer: The Alliance Commercial |
$34,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 100CM WITH MICRO INTRODUCER SET CPK55-11
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
4399654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,280.15 |
| Max. Negotiated Rate |
$8,036.20 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,241.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 3CM WITH MICRO INTRODUCER SET CPK83-11
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
4399655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,445.80 |
| Max. Negotiated Rate |
$34,940.00 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,445.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,677.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,888.11
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,551.25
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,677.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,241.00
|
| Rate for Payer: The Alliance Commercial |
$34,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 3CM WITH MICRO INTRODUCER SET CPK83-11
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
4399655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,280.15 |
| Max. Negotiated Rate |
$8,036.20 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,241.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 11MMMICRO INTRODUCER SET CPK54-11
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
4399653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,280.15 |
| Max. Negotiated Rate |
$8,036.20 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,241.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 11MMMICRO INTRODUCER SET CPK54-11
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
4399653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,445.80 |
| Max. Negotiated Rate |
$34,940.00 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,445.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,677.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,888.11
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,551.25
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,677.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,241.00
|
| Rate for Payer: The Alliance Commercial |
$34,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 7MMMICRO INTRODUCER SET CPK54-07
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
5286765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,280.15 |
| Max. Negotiated Rate |
$8,036.20 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,241.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 7MMMICRO INTRODUCER SET CPK54-07
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
5286765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,445.80 |
| Max. Negotiated Rate |
$34,940.00 |
| Rate for Payer: Aetna Commercial |
$7,861.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,512.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,445.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,677.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,629.55
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,036.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,888.11
|
| Rate for Payer: Health EOS Commercial |
$7,774.15
|
| Rate for Payer: HFN Commercial |
$8,036.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,551.25
|
| Rate for Payer: Multiplan Commercial |
$6,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,036.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,280.15
|
| Rate for Payer: Quartz Commercial |
$5,677.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,241.00
|
| Rate for Payer: The Alliance Commercial |
$34,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,804.25
|
| Rate for Payer: WPS Commercial |
$6,470.01
|
|
|
KIT COLAG 2 SCREW 3.0MM DISP INSTRUMENT SINGLE USE P06 S0003
|
Facility
|
IP
|
$3,990.00
|
|
| Hospital Charge Code |
6172082
|
|
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 COLAG 2 SCREW 3.0MM DISP INSTRUMENT SINGLE USE P06 S0003
|
Facility
|
OP
|
$3,990.00
|
|
| Hospital Charge Code |
6172082
|
|
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 COOLED RFA 17X100X4 CRKA-17-100-4
|
Facility
|
OP
|
$6,464.00
|
|
| Hospital Charge Code |
5414896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,809.92 |
| Max. Negotiated Rate |
$25,856.00 |
| Rate for Payer: Aetna Commercial |
$5,817.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,559.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,809.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,201.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,232.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,102.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.92
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cigna Commercial |
$5,946.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,617.25
|
| Rate for Payer: Health EOS Commercial |
$5,752.96
|
| Rate for Payer: HFN Commercial |
$5,946.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,848.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,946.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,167.36
|
| Rate for Payer: Quartz Commercial |
$4,201.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,878.40
|
| Rate for Payer: The Alliance Commercial |
$25,856.00
|
| Rate for Payer: WEA Trust Commercial |
$3,555.20
|
| Rate for Payer: WPS Commercial |
$4,787.88
|
|
|
KIT COOLED RFA 17X100X4 CRKA-17-100-4
|
Facility
|
IP
|
$6,464.00
|
|
| Hospital Charge Code |
5414896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,167.36 |
| Max. Negotiated Rate |
$5,946.88 |
| Rate for Payer: Aetna Commercial |
$5,817.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,559.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.92
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cigna Commercial |
$5,946.88
|
| Rate for Payer: Health EOS Commercial |
$5,752.96
|
| Rate for Payer: HFN Commercial |
$5,946.88
|
| Rate for Payer: Multiplan Commercial |
$5,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,946.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,167.36
|
| Rate for Payer: Quartz Commercial |
$3,878.40
|
| Rate for Payer: WEA Trust Commercial |
$3,555.20
|
| Rate for Payer: WPS Commercial |
$4,787.88
|
|
|
KIT COOLED RFA 17X100X4 MCKA2-17-100-4
|
Facility
|
OP
|
$8,616.00
|
|
| Hospital Charge Code |
5414897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,412.48 |
| Max. Negotiated Rate |
$34,464.00 |
| Rate for Payer: Aetna Commercial |
$7,754.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,409.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,412.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,600.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,135.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,566.48
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$7,926.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,821.51
|
| Rate for Payer: Health EOS Commercial |
$7,668.24
|
| Rate for Payer: HFN Commercial |
$7,926.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,462.00
|
| Rate for Payer: Multiplan Commercial |
$6,892.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,926.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,221.84
|
| Rate for Payer: Quartz Commercial |
$5,600.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,169.60
|
| Rate for Payer: The Alliance Commercial |
$34,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,738.80
|
| Rate for Payer: WPS Commercial |
$6,381.87
|
|
