|
KIT COOLED RFA 17X100X4 MCKA2-17-100-4
|
Facility
|
IP
|
$8,616.00
|
|
| Hospital Charge Code |
5414897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,221.84 |
| Max. Negotiated Rate |
$7,926.72 |
| Rate for Payer: Aetna Commercial |
$7,754.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,409.76
|
| 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: Health EOS Commercial |
$7,668.24
|
| Rate for Payer: HFN Commercial |
$7,926.72
|
| 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 |
$5,169.60
|
| Rate for Payer: WEA Trust Commercial |
$4,738.80
|
| Rate for Payer: WPS Commercial |
$6,381.87
|
|
|
KIT COOLED RFA 17 X 100 X 4 MCKA3-17-100-4
|
Facility
|
IP
|
$9,907.00
|
|
| Hospital Charge Code |
6049651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,854.43 |
| Max. Negotiated Rate |
$9,114.44 |
| Rate for Payer: Aetna Commercial |
$8,916.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,520.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,250.71
|
| Rate for Payer: Cash Price |
$2,972.10
|
| Rate for Payer: Cigna Commercial |
$9,114.44
|
| Rate for Payer: Health EOS Commercial |
$8,817.23
|
| Rate for Payer: HFN Commercial |
$9,114.44
|
| Rate for Payer: Multiplan Commercial |
$7,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,944.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,114.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,854.43
|
| Rate for Payer: Quartz Commercial |
$5,944.20
|
| Rate for Payer: WEA Trust Commercial |
$5,448.85
|
| Rate for Payer: WPS Commercial |
$7,338.11
|
|
|
KIT COOLED RFA 17 X 100 X 4 MCKA3-17-100-4
|
Facility
|
OP
|
$9,907.00
|
|
| Hospital Charge Code |
6049651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,773.96 |
| Max. Negotiated Rate |
$39,628.00 |
| Rate for Payer: Aetna Commercial |
$8,916.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,520.02
|
| Rate for Payer: Aetna Managed Medicare |
$2,773.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,439.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,953.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,755.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,250.71
|
| Rate for Payer: Cash Price |
$2,972.10
|
| Rate for Payer: Cigna Commercial |
$9,114.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,543.96
|
| Rate for Payer: Health EOS Commercial |
$8,817.23
|
| Rate for Payer: HFN Commercial |
$9,114.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,430.25
|
| Rate for Payer: Multiplan Commercial |
$7,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,944.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,114.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,854.43
|
| Rate for Payer: Quartz Commercial |
$6,439.55
|
| Rate for Payer: Quartz Medicare Advantage |
$5,944.20
|
| Rate for Payer: The Alliance Commercial |
$39,628.00
|
| Rate for Payer: WEA Trust Commercial |
$5,448.85
|
| Rate for Payer: WPS Commercial |
$7,338.11
|
|
|
KIT COOLED RFA 17 X 150 X 4 MCKA3-17-150-4
|
Facility
|
OP
|
$10,623.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6001651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,974.44 |
| Max. Negotiated Rate |
$42,492.00 |
| Rate for Payer: Aetna Commercial |
$9,560.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,135.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,974.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,904.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,311.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,099.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,630.19
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna Commercial |
$9,773.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,944.63
|
| Rate for Payer: Health EOS Commercial |
$9,454.47
|
| Rate for Payer: HFN Commercial |
$9,773.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,967.25
|
| Rate for Payer: Multiplan Commercial |
$8,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,373.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,773.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,205.27
|
| Rate for Payer: Quartz Commercial |
$6,904.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,373.80
|
| Rate for Payer: The Alliance Commercial |
$42,492.00
|
| Rate for Payer: WEA Trust Commercial |
$5,842.65
|
| Rate for Payer: WPS Commercial |
$7,868.46
|
|
|
KIT COOLED RFA 17 X 150 X 4 MCKA3-17-150-4
|
Facility
|
IP
|
$10,623.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6001651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,205.27 |
| Max. Negotiated Rate |
$9,773.16 |
| Rate for Payer: Aetna Commercial |
$9,560.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,135.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,630.19
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna Commercial |
$9,773.16
|
| Rate for Payer: Health EOS Commercial |
$9,454.47
|
| Rate for Payer: HFN Commercial |
$9,773.16
|
| Rate for Payer: Multiplan Commercial |
$8,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,373.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,773.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,205.27
|
| Rate for Payer: Quartz Commercial |
$6,373.80
|
| Rate for Payer: WEA Trust Commercial |
$5,842.65
|
| Rate for Payer: WPS Commercial |
$7,868.46
|
|
|
KIT COOLED RFA 17X50X4 CRKA-17-50-4
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5264979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,675.52 |
| Max. Negotiated Rate |
$23,936.00 |
| Rate for Payer: Aetna Commercial |
$5,385.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,146.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,889.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,992.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.52
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,505.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,348.65
|
| Rate for Payer: Health EOS Commercial |
$5,325.76
|
| Rate for Payer: HFN Commercial |
$5,505.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,488.00
|
| Rate for Payer: Multiplan Commercial |
$4,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.16
|
| Rate for Payer: Quartz Commercial |
$3,889.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,590.40
|
| Rate for Payer: The Alliance Commercial |
$23,936.00
|
| Rate for Payer: WEA Trust Commercial |
$3,291.20
|
| Rate for Payer: WPS Commercial |
$4,432.35
|
|
|
KIT COOLED RFA 17X50X4 CRKA-17-50-4
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5264979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,932.16 |
| Max. Negotiated Rate |
$5,505.28 |
| Rate for Payer: Aetna Commercial |
$5,385.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,146.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.52
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,505.28
|
| Rate for Payer: Health EOS Commercial |
$5,325.76
|
| Rate for Payer: HFN Commercial |
$5,505.28
|
| Rate for Payer: Multiplan Commercial |
$4,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.16
|
| Rate for Payer: Quartz Commercial |
$3,590.40
|
| Rate for Payer: WEA Trust Commercial |
$3,291.20
|
| Rate for Payer: WPS Commercial |
$4,432.35
|
|
|
KIT COOLED RFA 17X75X4 CRKA-17-75-4
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5264978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,932.16 |
| Max. Negotiated Rate |
$5,505.28 |
| Rate for Payer: Aetna Commercial |
$5,385.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,146.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.52
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,505.28
|
| Rate for Payer: Health EOS Commercial |
$5,325.76
|
| Rate for Payer: HFN Commercial |
$5,505.28
|
| Rate for Payer: Multiplan Commercial |
$4,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.16
|
| Rate for Payer: Quartz Commercial |
$3,590.40
|
| Rate for Payer: WEA Trust Commercial |
$3,291.20
|
| Rate for Payer: WPS Commercial |
$4,432.35
|
|
|
KIT COOLED RFA 17X75X4 CRKA-17-75-4
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5264978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,675.52 |
| Max. Negotiated Rate |
$23,936.00 |
| Rate for Payer: Aetna Commercial |
$5,385.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,146.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,889.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,992.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.52
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,505.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,348.65
|
| Rate for Payer: Health EOS Commercial |
$5,325.76
|
| Rate for Payer: HFN Commercial |
$5,505.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,488.00
|
| Rate for Payer: Multiplan Commercial |
$4,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.16
|
| Rate for Payer: Quartz Commercial |
$3,889.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,590.40
|
| Rate for Payer: The Alliance Commercial |
$23,936.00
|
| Rate for Payer: WEA Trust Commercial |
$3,291.20
|
| Rate for Payer: WPS Commercial |
$4,432.35
|
|
|
KIT COOLED RFA 17 X 75 X 4 MCKA3-17-75-4
|
Facility
|
IP
|
$10,214.00
|
|
| Hospital Charge Code |
6049652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,004.86 |
| Max. Negotiated Rate |
$9,396.88 |
| Rate for Payer: Aetna Commercial |
$9,192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,784.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,413.42
|
| Rate for Payer: Cash Price |
$3,064.20
|
| Rate for Payer: Cigna Commercial |
$9,396.88
|
| Rate for Payer: Health EOS Commercial |
$9,090.46
|
| Rate for Payer: HFN Commercial |
$9,396.88
|
| Rate for Payer: Multiplan Commercial |
$8,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,396.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,004.86
|
| Rate for Payer: Quartz Commercial |
$6,128.40
|
| Rate for Payer: WEA Trust Commercial |
$5,617.70
|
| Rate for Payer: WPS Commercial |
$7,565.51
|
|
|
KIT COOLED RFA 17 X 75 X 4 MCKA3-17-75-4
|
Facility
|
OP
|
$10,214.00
|
|
| Hospital Charge Code |
6049652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,859.92 |
| Max. Negotiated Rate |
$40,856.00 |
| Rate for Payer: Aetna Commercial |
$9,192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,784.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,859.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,639.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,902.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,413.42
|
| Rate for Payer: Cash Price |
$3,064.20
|
| Rate for Payer: Cigna Commercial |
$9,396.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,715.75
|
| Rate for Payer: Health EOS Commercial |
$9,090.46
|
| Rate for Payer: HFN Commercial |
$9,396.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,660.50
|
| Rate for Payer: Multiplan Commercial |
$8,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,396.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,004.86
|
| Rate for Payer: Quartz Commercial |
$6,639.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6,128.40
|
| Rate for Payer: The Alliance Commercial |
$40,856.00
|
| Rate for Payer: WEA Trust Commercial |
$5,617.70
|
| Rate for Payer: WPS Commercial |
$7,565.51
|
|
|
KIT CROSSFIX PROCEDURE DISP
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
KIT CROSSFIX PROCEDURE DISP
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
KIT CTS RELIEF 9971
|
Facility
|
OP
|
$1,912.00
|
|
| Hospital Charge Code |
2964882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.36 |
| Max. Negotiated Rate |
$7,648.00 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.32
|
| Rate for Payer: Aetna Managed Medicare |
$535.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,242.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$956.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$917.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.36
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cigna Commercial |
$1,759.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,069.96
|
| Rate for Payer: Health EOS Commercial |
$1,701.68
|
| Rate for Payer: HFN Commercial |
$1,759.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,434.00
|
| Rate for Payer: Multiplan Commercial |
$1,529.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,147.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.04
|
| Rate for Payer: Quartz Beloit One Network |
$936.88
|
| Rate for Payer: Quartz Commercial |
$1,242.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,147.20
|
| Rate for Payer: The Alliance Commercial |
$7,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,051.60
|
| Rate for Payer: WPS Commercial |
$1,416.22
|
|
|
KIT CTS RELIEF 9971
|
Facility
|
IP
|
$1,912.00
|
|
| Hospital Charge Code |
2964882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.88 |
| Max. Negotiated Rate |
$1,759.04 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.36
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cigna Commercial |
$1,759.04
|
| Rate for Payer: Health EOS Commercial |
$1,701.68
|
| Rate for Payer: HFN Commercial |
$1,759.04
|
| Rate for Payer: Multiplan Commercial |
$1,529.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,147.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.04
|
| Rate for Payer: Quartz Beloit One Network |
$936.88
|
| Rate for Payer: Quartz Commercial |
$1,147.20
|
| Rate for Payer: WEA Trust Commercial |
$1,051.60
|
| Rate for Payer: WPS Commercial |
$1,416.22
|
|
|
KIT CUSTOM MANIFOLD (QTY OF 10) K09-10187
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
2972968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$340.40 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$222.00
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$222.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
KIT CUSTOM MANIFOLD (QTY OF 10) K09-10187
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
2972968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$1,480.00 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Aetna Managed Medicare |
$103.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.05
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$277.50
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$222.00
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$240.50
|
| Rate for Payer: Quartz Medicare Advantage |
$222.00
|
| Rate for Payer: The Alliance Commercial |
$1,480.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
KIT CV MULTI LUMEN 7-8F SHEATH ARWAK21142SK
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
3065500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$437.92 |
| Max. Negotiated Rate |
$6,256.00 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.04
|
| Rate for Payer: Aetna Managed Medicare |
$437.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,016.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$782.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$750.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.92
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,438.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$875.21
|
| Rate for Payer: Health EOS Commercial |
$1,391.96
|
| Rate for Payer: HFN Commercial |
$1,438.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.00
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$938.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.88
|
| Rate for Payer: Quartz Beloit One Network |
$766.36
|
| Rate for Payer: Quartz Commercial |
$1,016.60
|
| Rate for Payer: Quartz Medicare Advantage |
$938.40
|
| Rate for Payer: The Alliance Commercial |
$6,256.00
|
| Rate for Payer: WEA Trust Commercial |
$860.20
|
| Rate for Payer: WPS Commercial |
$1,158.45
|
|
|
KIT CV MULTI LUMEN 7-8F SHEATH ARWAK21142SK
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
3065500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$766.36 |
| Max. Negotiated Rate |
$1,438.88 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.92
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,438.88
|
| Rate for Payer: Health EOS Commercial |
$1,391.96
|
| Rate for Payer: HFN Commercial |
$1,438.88
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$938.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.88
|
| Rate for Payer: Quartz Beloit One Network |
$766.36
|
| Rate for Payer: Quartz Commercial |
$938.40
|
| Rate for Payer: WEA Trust Commercial |
$860.20
|
| Rate for Payer: WPS Commercial |
$1,158.45
|
|
|
KIT DEMAYO KNEE POSITIONER 803-GP-10
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2965163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.87
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
KIT DEMAYO KNEE POSITIONER 803-GP-10
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2965163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
KIT DISP DX KNOTLESS FIBERTAK AR-8991DS
|
Facility
|
IP
|
$2,601.00
|
|
| Hospital Charge Code |
6181680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,274.49 |
| Max. Negotiated Rate |
$2,392.92 |
| Rate for Payer: Aetna Commercial |
$2,340.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,236.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,378.53
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cigna Commercial |
$2,392.92
|
| Rate for Payer: Health EOS Commercial |
$2,314.89
|
| Rate for Payer: HFN Commercial |
$2,392.92
|
| Rate for Payer: Multiplan Commercial |
$2,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,560.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,392.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.49
|
| Rate for Payer: Quartz Commercial |
$1,560.60
|
| Rate for Payer: WEA Trust Commercial |
$1,430.55
|
| Rate for Payer: WPS Commercial |
$1,926.56
|
|
|
KIT DISP DX KNOTLESS FIBERTAK AR-8991DS
|
Facility
|
OP
|
$2,601.00
|
|
| Hospital Charge Code |
6181680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.28 |
| Max. Negotiated Rate |
$10,404.00 |
| Rate for Payer: Aetna Commercial |
$2,340.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,236.86
|
| Rate for Payer: Aetna Managed Medicare |
$728.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,690.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,300.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,248.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,378.53
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cigna Commercial |
$2,392.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,455.52
|
| Rate for Payer: Health EOS Commercial |
$2,314.89
|
| Rate for Payer: HFN Commercial |
$2,392.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,950.75
|
| Rate for Payer: Multiplan Commercial |
$2,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,560.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,392.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.49
|
| Rate for Payer: Quartz Commercial |
$1,690.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,560.60
|
| Rate for Payer: The Alliance Commercial |
$10,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,430.55
|
| Rate for Payer: WPS Commercial |
$1,926.56
|
|
|
KIT DISP INSTR 3.9MM KNOTLESS CORKSCREW AR-1941DS
|
Facility
|
OP
|
$4,490.00
|
|
| Hospital Charge Code |
5547341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,257.20 |
| Max. Negotiated Rate |
$17,960.00 |
| Rate for Payer: Aetna Commercial |
$4,041.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,861.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,918.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,155.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,379.70
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$4,130.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,512.60
|
| Rate for Payer: Health EOS Commercial |
$3,996.10
|
| Rate for Payer: HFN Commercial |
$4,130.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,367.50
|
| Rate for Payer: Multiplan Commercial |
$3,592.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,694.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,200.10
|
| Rate for Payer: Quartz Commercial |
$2,918.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,694.00
|
| Rate for Payer: The Alliance Commercial |
$17,960.00
|
| Rate for Payer: WEA Trust Commercial |
$2,469.50
|
| Rate for Payer: WPS Commercial |
$3,325.74
|
|
|
KIT DISP INSTR 3.9MM KNOTLESS CORKSCREW AR-1941DS
|
Facility
|
IP
|
$4,490.00
|
|
| Hospital Charge Code |
5547341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,200.10 |
| Max. Negotiated Rate |
$4,130.80 |
| Rate for Payer: Aetna Commercial |
$4,041.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,861.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,379.70
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$4,130.80
|
| Rate for Payer: Health EOS Commercial |
$3,996.10
|
| Rate for Payer: HFN Commercial |
$4,130.80
|
| Rate for Payer: Multiplan Commercial |
$3,592.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,694.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,200.10
|
| Rate for Payer: Quartz Commercial |
$2,694.00
|
| Rate for Payer: WEA Trust Commercial |
$2,469.50
|
| Rate for Payer: WPS Commercial |
$3,325.74
|
|
