|
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 |
$6,713.98 |
| Max. Negotiated Rate |
$12,605.84 |
| Rate for Payer: Aetna Commercial |
$12,331.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,783.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,262.06
|
| Rate for Payer: Cash Price |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$12,605.84
|
| Rate for Payer: Health EOS Commercial |
$12,194.78
|
| Rate for Payer: HFN Commercial |
$12,605.84
|
| Rate for Payer: Multiplan Commercial |
$10,961.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,605.84
|
| Rate for Payer: Quartz Beloit One Network |
$6,713.98
|
| Rate for Payer: Quartz Commercial |
$8,221.20
|
| Rate for Payer: WEA Trust Commercial |
$7,536.10
|
| Rate for Payer: WPS Commercial |
$10,148.70
|
|
|
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 |
$3,836.56 |
| Max. Negotiated Rate |
$12,605.84 |
| Rate for Payer: Aetna Commercial |
$12,331.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,783.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,836.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,906.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,851.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,576.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,262.06
|
| Rate for Payer: Cash Price |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$12,605.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,667.85
|
| Rate for Payer: Health EOS Commercial |
$12,194.78
|
| Rate for Payer: HFN Commercial |
$12,605.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,276.50
|
| Rate for Payer: Multiplan Commercial |
$10,961.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,221.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,605.84
|
| Rate for Payer: Quartz Beloit One Network |
$6,713.98
|
| Rate for Payer: Quartz Commercial |
$8,906.30
|
| Rate for Payer: Quartz Medicare Advantage |
$8,221.20
|
| Rate for Payer: The Alliance Commercial |
$6,851.00
|
| Rate for Payer: WEA Trust Commercial |
$7,536.10
|
| Rate for Payer: WPS Commercial |
$10,148.70
|
|
|
KIT CATARACT FRIEDRICHS
|
Facility
|
IP
|
$6,953.00
|
|
| Hospital Charge Code |
5563688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,543.25 |
| Max. Negotiated Rate |
$6,652.63 |
| Rate for Payer: Aetna Commercial |
$6,508.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,218.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,832.49
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,652.63
|
| Rate for Payer: Health EOS Commercial |
$6,435.70
|
| Rate for Payer: HFN Commercial |
$6,652.63
|
| Rate for Payer: Multiplan Commercial |
$5,784.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,652.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,543.25
|
| Rate for Payer: Quartz Commercial |
$4,338.67
|
| Rate for Payer: WEA Trust Commercial |
$3,977.12
|
| Rate for Payer: WPS Commercial |
$5,355.90
|
|
|
KIT CATARACT FRIEDRICHS
|
Facility
|
OP
|
$6,953.00
|
|
| Hospital Charge Code |
5563688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,024.71 |
| Max. Negotiated Rate |
$6,652.63 |
| Rate for Payer: Aetna Commercial |
$6,508.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,218.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,700.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,615.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,470.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,832.49
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,652.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,046.65
|
| Rate for Payer: Health EOS Commercial |
$6,435.70
|
| Rate for Payer: HFN Commercial |
$6,652.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,423.34
|
| Rate for Payer: Multiplan Commercial |
$5,784.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,338.67
|
| Rate for Payer: Preferred Network Access Commercial |
$6,652.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,543.25
|
| Rate for Payer: Quartz Commercial |
$4,700.23
|
| Rate for Payer: Quartz Medicare Advantage |
$4,338.67
|
| Rate for Payer: The Alliance Commercial |
$3,615.56
|
| Rate for Payer: WEA Trust Commercial |
$3,977.12
|
| Rate for Payer: WPS Commercial |
$5,355.90
|
|
|
KIT CATARACT ROJAS
|
Facility
|
IP
|
$4,501.00
|
|
| Hospital Charge Code |
5563687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,293.71 |
| Max. Negotiated Rate |
$4,306.56 |
| Rate for Payer: Aetna Commercial |
$4,212.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,025.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.95
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Cigna Commercial |
$4,306.56
|
| Rate for Payer: Health EOS Commercial |
$4,166.13
|
| Rate for Payer: HFN Commercial |
$4,306.56
|
| Rate for Payer: Multiplan Commercial |
$3,744.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.71
|
| Rate for Payer: Quartz Commercial |
$2,808.62
|
| Rate for Payer: WEA Trust Commercial |
$2,574.57
|
| Rate for Payer: WPS Commercial |
$3,467.12
|
|
|
KIT CATARACT ROJAS
|
Facility
|
OP
|
$4,501.00
|
|
| Hospital Charge Code |
5563687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.69 |
| Max. Negotiated Rate |
$4,306.56 |
| Rate for Payer: Aetna Commercial |
$4,212.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,025.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,310.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,042.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,340.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,246.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.95
|
| Rate for Payer: Cash Price |
$1,350.30
|
| Rate for Payer: Cigna Commercial |
$4,306.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,619.58
|
| Rate for Payer: Health EOS Commercial |
$4,166.13
|
| Rate for Payer: HFN Commercial |
$4,306.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,510.78
|
| Rate for Payer: Multiplan Commercial |
$3,744.83
|
| Rate for Payer: NAPHCARE Commercial |
$2,808.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.71
|
| Rate for Payer: Quartz Commercial |
$3,042.68
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.62
|
| Rate for Payer: The Alliance Commercial |
$2,340.52
|
| Rate for Payer: WEA Trust Commercial |
$2,574.57
|
| Rate for Payer: WPS Commercial |
$3,467.12
|
|
|
KIT CATARACT TOWNSHEND
|
Facility
|
OP
|
$4,175.00
|
|
| Hospital Charge Code |
5563686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,215.76 |
| Max. Negotiated Rate |
$3,994.64 |
| Rate for Payer: Aetna Commercial |
$3,907.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,734.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,215.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,822.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,084.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,301.26
|
| Rate for Payer: Cash Price |
$1,252.50
|
| Rate for Payer: Cigna Commercial |
$3,994.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,429.85
|
| Rate for Payer: Health EOS Commercial |
$3,864.38
|
| Rate for Payer: HFN Commercial |
$3,994.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,256.50
|
| Rate for Payer: Multiplan Commercial |
$3,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,605.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,994.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,127.58
|
| Rate for Payer: Quartz Commercial |
$2,822.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,605.20
|
| Rate for Payer: The Alliance Commercial |
$2,171.00
|
| Rate for Payer: WEA Trust Commercial |
$2,388.10
|
| Rate for Payer: WPS Commercial |
$3,216.00
|
|
|
KIT CATARACT TOWNSHEND
|
Facility
|
IP
|
$4,175.00
|
|
| Hospital Charge Code |
5563686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,127.58 |
| Max. Negotiated Rate |
$3,994.64 |
| Rate for Payer: Aetna Commercial |
$3,907.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,734.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,301.26
|
| Rate for Payer: Cash Price |
$1,252.50
|
| Rate for Payer: Cigna Commercial |
$3,994.64
|
| Rate for Payer: Health EOS Commercial |
$3,864.38
|
| Rate for Payer: HFN Commercial |
$3,994.64
|
| Rate for Payer: Multiplan Commercial |
$3,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,994.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,127.58
|
| Rate for Payer: Quartz Commercial |
$2,605.20
|
| Rate for Payer: WEA Trust Commercial |
$2,388.10
|
| Rate for Payer: WPS Commercial |
$3,216.00
|
|
|
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 |
$1,087.63 |
| Max. Negotiated Rate |
$3,573.65 |
| Rate for Payer: Aetna Commercial |
$3,495.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,340.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,524.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,864.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,058.73
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,573.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,173.77
|
| Rate for Payer: Health EOS Commercial |
$3,457.12
|
| Rate for Payer: HFN Commercial |
$3,573.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,913.30
|
| Rate for Payer: Multiplan Commercial |
$3,107.52
|
| Rate for Payer: NAPHCARE Commercial |
$2,330.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,573.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.36
|
| Rate for Payer: Quartz Commercial |
$2,524.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,330.64
|
| Rate for Payer: The Alliance Commercial |
$1,942.20
|
| Rate for Payer: WEA Trust Commercial |
$2,136.42
|
| Rate for Payer: WPS Commercial |
$2,877.07
|
|
|
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 |
$1,903.36 |
| Max. Negotiated Rate |
$3,573.65 |
| Rate for Payer: Aetna Commercial |
$3,495.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,340.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,058.73
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,573.65
|
| Rate for Payer: Health EOS Commercial |
$3,457.12
|
| Rate for Payer: HFN Commercial |
$3,573.65
|
| Rate for Payer: Multiplan Commercial |
$3,107.52
|
| Rate for Payer: Preferred Network Access Commercial |
$3,573.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.36
|
| Rate for Payer: Quartz Commercial |
$2,330.64
|
| Rate for Payer: WEA Trust Commercial |
$2,136.42
|
| Rate for Payer: WPS Commercial |
$2,877.07
|
|
|
KIT CATHETER PED/INFANT 5 FR
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2963308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
KIT CATHETER PED/INFANT 5 FR
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2963308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
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 |
$725.67 |
| Max. Negotiated Rate |
$2,384.35 |
| Rate for Payer: Aetna Commercial |
$2,332.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.84
|
| Rate for Payer: Aetna Managed Medicare |
$725.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,684.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,295.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,244.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.59
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$2,384.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.34
|
| Rate for Payer: Health EOS Commercial |
$2,306.60
|
| Rate for Payer: HFN Commercial |
$2,384.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,943.76
|
| Rate for Payer: Multiplan Commercial |
$2,073.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,384.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.92
|
| Rate for Payer: Quartz Commercial |
$1,684.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,555.01
|
| Rate for Payer: The Alliance Commercial |
$1,295.84
|
| Rate for Payer: WEA Trust Commercial |
$1,425.42
|
| Rate for Payer: WPS Commercial |
$1,919.59
|
|
|
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 |
$1,269.92 |
| Max. Negotiated Rate |
$2,384.35 |
| Rate for Payer: Aetna Commercial |
$2,332.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.59
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$2,384.35
|
| Rate for Payer: Health EOS Commercial |
$2,306.60
|
| Rate for Payer: HFN Commercial |
$2,384.35
|
| Rate for Payer: Multiplan Commercial |
$2,073.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,384.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.92
|
| Rate for Payer: Quartz Commercial |
$1,555.01
|
| Rate for Payer: WEA Trust Commercial |
$1,425.42
|
| Rate for Payer: WPS Commercial |
$1,919.59
|
|
|
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 |
$488.05 |
| Max. Negotiated Rate |
$1,603.60 |
| Rate for Payer: Aetna Commercial |
$1,568.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,499.01
|
| Rate for Payer: Aetna Managed Medicare |
$488.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,132.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$871.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$836.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.81
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$1,603.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$975.43
|
| Rate for Payer: Health EOS Commercial |
$1,551.31
|
| Rate for Payer: HFN Commercial |
$1,603.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,307.28
|
| Rate for Payer: Multiplan Commercial |
$1,394.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.09
|
| Rate for Payer: Quartz Commercial |
$1,132.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,045.82
|
| Rate for Payer: The Alliance Commercial |
$871.52
|
| Rate for Payer: WEA Trust Commercial |
$958.67
|
| Rate for Payer: WPS Commercial |
$1,291.02
|
|
|
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 |
$854.09 |
| Max. Negotiated Rate |
$1,603.60 |
| Rate for Payer: Aetna Commercial |
$1,568.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,499.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.81
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$1,603.60
|
| Rate for Payer: Health EOS Commercial |
$1,551.31
|
| Rate for Payer: HFN Commercial |
$1,603.60
|
| Rate for Payer: Multiplan Commercial |
$1,394.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.09
|
| Rate for Payer: Quartz Commercial |
$1,045.82
|
| Rate for Payer: WEA Trust Commercial |
$958.67
|
| Rate for Payer: WPS Commercial |
$1,291.02
|
|
|
KIT CENTURION ULTRASOUND FLUID MANAGEMENT 8065752201
|
Facility
|
OP
|
$343.00
|
|
| Hospital Charge Code |
5107100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$328.18 |
| Rate for Payer: Aetna Commercial |
$321.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.78
|
| Rate for Payer: Aetna Managed Medicare |
$99.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.06
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$328.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.63
|
| Rate for Payer: Health EOS Commercial |
$317.48
|
| Rate for Payer: HFN Commercial |
$328.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.54
|
| Rate for Payer: Multiplan Commercial |
$285.38
|
| Rate for Payer: NAPHCARE Commercial |
$214.03
|
| Rate for Payer: Preferred Network Access Commercial |
$328.18
|
| Rate for Payer: Quartz Beloit One Network |
$174.79
|
| Rate for Payer: Quartz Commercial |
$231.87
|
| Rate for Payer: Quartz Medicare Advantage |
$214.03
|
| Rate for Payer: The Alliance Commercial |
$178.36
|
| Rate for Payer: WEA Trust Commercial |
$196.20
|
| Rate for Payer: WPS Commercial |
$264.21
|
|
|
KIT CENTURION ULTRASOUND FLUID MANAGEMENT 8065752201
|
Facility
|
IP
|
$343.00
|
|
| Hospital Charge Code |
5107100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.79 |
| Max. Negotiated Rate |
$328.18 |
| Rate for Payer: Aetna Commercial |
$321.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.06
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$328.18
|
| Rate for Payer: Health EOS Commercial |
$317.48
|
| Rate for Payer: HFN Commercial |
$328.18
|
| Rate for Payer: Multiplan Commercial |
$285.38
|
| Rate for Payer: Preferred Network Access Commercial |
$328.18
|
| Rate for Payer: Quartz Beloit One Network |
$174.79
|
| Rate for Payer: Quartz Commercial |
$214.03
|
| Rate for Payer: WEA Trust Commercial |
$196.20
|
| Rate for Payer: WPS Commercial |
$264.21
|
|
|
KIT CENTURION ULTRAVIT VITRECTOMY 8065752134
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
5107101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
KIT CENTURION ULTRAVIT VITRECTOMY 8065752134
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
5107101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$196.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$351.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.85
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.50
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$421.20
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
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 |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
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 |
$158.12 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$338.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$338.83
|
| Rate for Payer: The Alliance Commercial |
$282.36
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
KIT CIRCUIT CPAP / O2 #RT324
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
2973589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
KIT CIRCUIT CPAP / O2 #RT324
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
2973589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
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 |
$2,543.63 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,543.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,904.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,542.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,360.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,083.77
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,813.30
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,904.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5,450.64
|
| Rate for Payer: The Alliance Commercial |
$4,542.20
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
