|
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 |
$4,451.36 |
| 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: 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: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| 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 |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
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 |
$4,451.36 |
| 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: 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: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| 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 |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
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 |
$2,543.63 |
| 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
|
|
|
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 |
$4,451.36 |
| 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: 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: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| 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 |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
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 |
$2,543.63 |
| 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
|
|
|
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 |
$2,543.63 |
| 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
|
|
|
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 |
$4,451.36 |
| 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: 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: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| 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 |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
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 |
$1,161.89 |
| Max. Negotiated Rate |
$3,817.63 |
| Rate for Payer: Aetna Commercial |
$3,734.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,568.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,161.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,697.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,074.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,991.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,199.29
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$3,817.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,322.18
|
| Rate for Payer: Health EOS Commercial |
$3,693.14
|
| Rate for Payer: HFN Commercial |
$3,817.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,112.20
|
| Rate for Payer: Multiplan Commercial |
$3,319.68
|
| Rate for Payer: NAPHCARE Commercial |
$2,489.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,817.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,033.30
|
| Rate for Payer: Quartz Commercial |
$2,697.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,489.76
|
| Rate for Payer: The Alliance Commercial |
$2,074.80
|
| Rate for Payer: WEA Trust Commercial |
$2,282.28
|
| Rate for Payer: WPS Commercial |
$3,073.50
|
|
|
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 |
$2,033.30 |
| Max. Negotiated Rate |
$3,817.63 |
| Rate for Payer: Aetna Commercial |
$3,734.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,568.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,199.29
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$3,817.63
|
| Rate for Payer: Health EOS Commercial |
$3,693.14
|
| Rate for Payer: HFN Commercial |
$3,817.63
|
| Rate for Payer: Multiplan Commercial |
$3,319.68
|
| Rate for Payer: Preferred Network Access Commercial |
$3,817.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,033.30
|
| Rate for Payer: Quartz Commercial |
$2,489.76
|
| Rate for Payer: WEA Trust Commercial |
$2,282.28
|
| Rate for Payer: WPS Commercial |
$3,073.50
|
|
|
KIT COOLED RFA 17X100X4 CRKA-17-100-4
|
Facility
|
IP
|
$6,464.00
|
|
| Hospital Charge Code |
5414896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,294.05 |
| Max. Negotiated Rate |
$6,184.76 |
| Rate for Payer: Aetna Commercial |
$6,050.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,781.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.96
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cigna Commercial |
$6,184.76
|
| Rate for Payer: Health EOS Commercial |
$5,983.08
|
| Rate for Payer: HFN Commercial |
$6,184.76
|
| Rate for Payer: Multiplan Commercial |
$5,378.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,184.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,294.05
|
| Rate for Payer: Quartz Commercial |
$4,033.54
|
| Rate for Payer: WEA Trust Commercial |
$3,697.41
|
| Rate for Payer: WPS Commercial |
$4,979.22
|
|
|
KIT COOLED RFA 17X100X4 CRKA-17-100-4
|
Facility
|
OP
|
$6,464.00
|
|
| Hospital Charge Code |
5414896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,882.32 |
| Max. Negotiated Rate |
$6,184.76 |
| Rate for Payer: Aetna Commercial |
$6,050.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,781.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,882.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,369.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,361.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,226.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.96
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cigna Commercial |
$6,184.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,762.05
|
| Rate for Payer: Health EOS Commercial |
$5,983.08
|
| Rate for Payer: HFN Commercial |
$6,184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,041.92
|
| Rate for Payer: Multiplan Commercial |
$5,378.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,033.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,184.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,294.05
|
| Rate for Payer: Quartz Commercial |
$4,369.66
|
| Rate for Payer: Quartz Medicare Advantage |
$4,033.54
|
| Rate for Payer: The Alliance Commercial |
$3,361.28
|
| Rate for Payer: WEA Trust Commercial |
$3,697.41
|
| Rate for Payer: WPS Commercial |
$4,979.22
|
|
|
KIT COOLED RFA 17X100X4 MCKA2-17-100-4
|
Facility
|
IP
|
$8,616.00
|
|
| Hospital Charge Code |
5414897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,390.71 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,376.38
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
KIT COOLED RFA 17X100X4 MCKA2-17-100-4
|
Facility
|
OP
|
$8,616.00
|
|
| Hospital Charge Code |
5414897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,508.98 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,508.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,824.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,480.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,301.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,014.51
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,720.48
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,376.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,824.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,376.38
|
| Rate for Payer: The Alliance Commercial |
$4,480.32
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
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 |
$2,884.92 |
| Max. Negotiated Rate |
$9,479.02 |
| Rate for Payer: Aetna Commercial |
$9,272.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,860.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,884.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,697.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,151.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,945.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,460.74
|
| Rate for Payer: Cash Price |
$2,972.10
|
| Rate for Payer: Cigna Commercial |
$9,479.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,765.87
|
| Rate for Payer: Health EOS Commercial |
$9,169.92
|
| Rate for Payer: HFN Commercial |
$9,479.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,727.46
|
| Rate for Payer: Multiplan Commercial |
$8,242.62
|
| Rate for Payer: NAPHCARE Commercial |
$6,181.97
|
| Rate for Payer: Preferred Network Access Commercial |
$9,479.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,048.61
|
| Rate for Payer: Quartz Commercial |
$6,697.13
|
| Rate for Payer: Quartz Medicare Advantage |
$6,181.97
|
| Rate for Payer: The Alliance Commercial |
$5,151.64
|
| Rate for Payer: WEA Trust Commercial |
$5,666.80
|
| Rate for Payer: WPS Commercial |
$7,631.36
|
|
|
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 |
$5,048.61 |
| Max. Negotiated Rate |
$9,479.02 |
| Rate for Payer: Aetna Commercial |
$9,272.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,860.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,460.74
|
| Rate for Payer: Cash Price |
$2,972.10
|
| Rate for Payer: Cigna Commercial |
$9,479.02
|
| Rate for Payer: Health EOS Commercial |
$9,169.92
|
| Rate for Payer: HFN Commercial |
$9,479.02
|
| Rate for Payer: Multiplan Commercial |
$8,242.62
|
| Rate for Payer: Preferred Network Access Commercial |
$9,479.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,048.61
|
| Rate for Payer: Quartz Commercial |
$6,181.97
|
| Rate for Payer: WEA Trust Commercial |
$5,666.80
|
| Rate for Payer: WPS Commercial |
$7,631.36
|
|
|
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 |
$3,093.42 |
| Max. Negotiated Rate |
$10,164.09 |
| Rate for Payer: Aetna Commercial |
$9,943.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,501.21
|
| Rate for Payer: Aetna Managed Medicare |
$3,093.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,181.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,523.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,303.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,855.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna Commercial |
$10,164.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,182.59
|
| Rate for Payer: Health EOS Commercial |
$9,832.65
|
| Rate for Payer: HFN Commercial |
$10,164.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,285.94
|
| Rate for Payer: Multiplan Commercial |
$8,838.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,628.75
|
| Rate for Payer: Preferred Network Access Commercial |
$10,164.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,413.48
|
| Rate for Payer: Quartz Commercial |
$7,181.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6,628.75
|
| Rate for Payer: The Alliance Commercial |
$5,523.96
|
| Rate for Payer: WEA Trust Commercial |
$6,076.36
|
| Rate for Payer: WPS Commercial |
$8,182.90
|
|
|
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 |
$5,413.48 |
| Max. Negotiated Rate |
$10,164.09 |
| Rate for Payer: Aetna Commercial |
$9,943.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,501.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,855.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna Commercial |
$10,164.09
|
| Rate for Payer: Health EOS Commercial |
$9,832.65
|
| Rate for Payer: HFN Commercial |
$10,164.09
|
| Rate for Payer: Multiplan Commercial |
$8,838.34
|
| Rate for Payer: Preferred Network Access Commercial |
$10,164.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,413.48
|
| Rate for Payer: Quartz Commercial |
$6,628.75
|
| Rate for Payer: WEA Trust Commercial |
$6,076.36
|
| Rate for Payer: WPS Commercial |
$8,182.90
|
|
|
KIT COOLED RFA 17X50X4 CRKA-17-50-4
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5264979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,049.45 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$3,734.02
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17X50X4 CRKA-17-50-4
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5264979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,742.54 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.69
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,667.52
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$4,045.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.02
|
| Rate for Payer: The Alliance Commercial |
$3,111.68
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17X75X4 CRKA-17-75-4
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5264978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,742.54 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.69
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,667.52
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$4,045.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.02
|
| Rate for Payer: The Alliance Commercial |
$3,111.68
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17X75X4 CRKA-17-75-4
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5264978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,049.45 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$3,734.02
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
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 |
$2,974.32 |
| Max. Negotiated Rate |
$9,772.76 |
| Rate for Payer: Aetna Commercial |
$9,560.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,135.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,974.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,904.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,311.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,098.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,629.96
|
| Rate for Payer: Cash Price |
$3,064.20
|
| Rate for Payer: Cigna Commercial |
$9,772.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,944.55
|
| Rate for Payer: Health EOS Commercial |
$9,454.08
|
| Rate for Payer: HFN Commercial |
$9,772.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,966.92
|
| Rate for Payer: Multiplan Commercial |
$8,498.05
|
| Rate for Payer: NAPHCARE Commercial |
$6,373.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,772.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,205.05
|
| Rate for Payer: Quartz Commercial |
$6,904.66
|
| Rate for Payer: Quartz Medicare Advantage |
$6,373.54
|
| Rate for Payer: The Alliance Commercial |
$5,311.28
|
| Rate for Payer: WEA Trust Commercial |
$5,842.41
|
| Rate for Payer: WPS Commercial |
$7,867.84
|
|
|
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 |
$5,205.05 |
| Max. Negotiated Rate |
$9,772.76 |
| Rate for Payer: Aetna Commercial |
$9,560.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,135.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,629.96
|
| Rate for Payer: Cash Price |
$3,064.20
|
| Rate for Payer: Cigna Commercial |
$9,772.76
|
| Rate for Payer: Health EOS Commercial |
$9,454.08
|
| Rate for Payer: HFN Commercial |
$9,772.76
|
| Rate for Payer: Multiplan Commercial |
$8,498.05
|
| Rate for Payer: Preferred Network Access Commercial |
$9,772.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,205.05
|
| Rate for Payer: Quartz Commercial |
$6,373.54
|
| Rate for Payer: WEA Trust Commercial |
$5,842.41
|
| Rate for Payer: WPS Commercial |
$7,867.84
|
|
|
KIT CROSSFIX PROCEDURE DISP
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
KIT CROSSFIX PROCEDURE DISP
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
