|
KIT DISP SWIVELOCK 3.5 X 8.5MM AR-8978DS
|
Facility
|
IP
|
$4,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.18 |
| Max. Negotiated Rate |
$3,847.44 |
| Rate for Payer: Aetna Commercial |
$3,763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,596.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,216.46
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$3,847.44
|
| Rate for Payer: Health EOS Commercial |
$3,721.98
|
| Rate for Payer: HFN Commercial |
$3,847.44
|
| Rate for Payer: Multiplan Commercial |
$3,345.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,509.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,847.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,049.18
|
| Rate for Payer: Quartz Commercial |
$2,509.20
|
| Rate for Payer: WEA Trust Commercial |
$2,300.10
|
| Rate for Payer: WPS Commercial |
$3,097.61
|
|
|
KIT DISP SWIVELOCK 3.5 X 8.5MM AR-8978DS
|
Facility
|
OP
|
$4,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.96 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$3,763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,596.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,170.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,718.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,007.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,216.46
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$3,847.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,340.25
|
| Rate for Payer: Health EOS Commercial |
$3,721.98
|
| Rate for Payer: HFN Commercial |
$3,847.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,345.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,509.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,847.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,049.18
|
| Rate for Payer: Quartz Commercial |
$2,718.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,509.20
|
| Rate for Payer: The Alliance Commercial |
$16,728.00
|
| Rate for Payer: WEA Trust Commercial |
$2,300.10
|
| Rate for Payer: WPS Commercial |
$3,097.61
|
|
|
KIT DRAINAGE ESSENTIAL 4992508
|
Facility
|
OP
|
$5,624.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
6153670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,574.72 |
| Max. Negotiated Rate |
$22,496.00 |
| Rate for Payer: Aetna Commercial |
$5,061.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,836.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,574.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,655.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,812.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,699.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,980.72
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cigna Commercial |
$5,174.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.19
|
| Rate for Payer: Health EOS Commercial |
$5,005.36
|
| Rate for Payer: HFN Commercial |
$5,174.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,218.00
|
| Rate for Payer: Multiplan Commercial |
$4,499.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,174.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,755.76
|
| Rate for Payer: Quartz Commercial |
$3,655.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,374.40
|
| Rate for Payer: The Alliance Commercial |
$22,496.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.20
|
| Rate for Payer: WPS Commercial |
$4,165.70
|
|
|
KIT DRAINAGE ESSENTIAL 4992508
|
Facility
|
IP
|
$5,624.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
6153670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,755.76 |
| Max. Negotiated Rate |
$5,174.08 |
| Rate for Payer: Aetna Commercial |
$5,061.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,836.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,980.72
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cigna Commercial |
$5,174.08
|
| Rate for Payer: Health EOS Commercial |
$5,005.36
|
| Rate for Payer: HFN Commercial |
$5,174.08
|
| Rate for Payer: Multiplan Commercial |
$4,499.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,174.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,755.76
|
| Rate for Payer: Quartz Commercial |
$3,374.40
|
| Rate for Payer: WEA Trust Commercial |
$3,093.20
|
| Rate for Payer: WPS Commercial |
$4,165.70
|
|
|
KIT DRAINAGE STARTER KIT 4992509
|
Facility
|
IP
|
$3,028.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
6153679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,483.72 |
| Max. Negotiated Rate |
$2,785.76 |
| Rate for Payer: Aetna Commercial |
$2,725.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,604.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,604.84
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$2,785.76
|
| Rate for Payer: Health EOS Commercial |
$2,694.92
|
| Rate for Payer: HFN Commercial |
$2,785.76
|
| Rate for Payer: Multiplan Commercial |
$2,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,816.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,785.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,483.72
|
| Rate for Payer: Quartz Commercial |
$1,816.80
|
| Rate for Payer: WEA Trust Commercial |
$1,665.40
|
| Rate for Payer: WPS Commercial |
$2,242.84
|
|
|
KIT DRAINAGE STARTER KIT 4992509
|
Facility
|
OP
|
$3,028.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
6153679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.84 |
| Max. Negotiated Rate |
$12,112.00 |
| Rate for Payer: Aetna Commercial |
$2,725.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,604.08
|
| Rate for Payer: Aetna Managed Medicare |
$847.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,968.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,514.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,453.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,604.84
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$2,785.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,694.47
|
| Rate for Payer: Health EOS Commercial |
$2,694.92
|
| Rate for Payer: HFN Commercial |
$2,785.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,271.00
|
| Rate for Payer: Multiplan Commercial |
$2,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,816.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,785.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,483.72
|
| Rate for Payer: Quartz Commercial |
$1,968.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,816.80
|
| Rate for Payer: The Alliance Commercial |
$12,112.00
|
| Rate for Payer: WEA Trust Commercial |
$1,665.40
|
| Rate for Payer: WPS Commercial |
$2,242.84
|
|
|
Kit Duo Trach
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
3101738
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
Kit Duo Trach
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
3101738
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Aetna Managed Medicare |
$49.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.93
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$113.75
|
| Rate for Payer: Quartz Medicare Advantage |
$105.00
|
| Rate for Payer: The Alliance Commercial |
$700.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
KIT ENDOSCOPIC FOG DEFOGGER 220-50
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
KIT ENDOSCOPIC FOG DEFOGGER 220-50
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
KIT ESSENTIAL PG #04494-10
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
2973508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.92 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$484.80
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
KIT ESSENTIAL PG #04494-10
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
2973508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.24 |
| Max. Negotiated Rate |
$3,232.00 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Aetna Managed Medicare |
$226.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.16
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.00
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$525.20
|
| Rate for Payer: Quartz Medicare Advantage |
$484.80
|
| Rate for Payer: The Alliance Commercial |
$3,232.00
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
KIT EXPECTANT FATHERS X-LARGE SCRUB DISPOSABLE
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
2963271
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
KIT EXPECTANT FATHERS X-LARGE SCRUB DISPOSABLE
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
2963271
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
KIT FAST PACK CELL SAVER ELITE 125ML CSE-FP-125V
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5804219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
KIT FAST PACK CELL SAVER ELITE 125ML CSE-FP-125V
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5804219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
KIT FAST PACK CELL SAVER ELITE 225ML CSE-FP-225V
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5804218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
KIT FAST PACK CELL SAVER ELITE 225ML CSE-FP-225V
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5804218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
KIT FATHER LARGE
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
2963284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
KIT FATHER LARGE
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
2963284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
KIT FEMORAL ARTERY 20G 8CM SAC-00820-1A
|
Facility
|
IP
|
$772.00
|
|
| Hospital Charge Code |
5641660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.28 |
| Max. Negotiated Rate |
$710.24 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$463.20
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
KIT FEMORAL ARTERY 20G 8CM SAC-00820-1A
|
Facility
|
OP
|
$772.00
|
|
| Hospital Charge Code |
5641660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.16 |
| Max. Negotiated Rate |
$3,088.00 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Aetna Managed Medicare |
$216.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$501.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$386.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$370.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.01
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.00
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$501.80
|
| Rate for Payer: Quartz Medicare Advantage |
$463.20
|
| Rate for Payer: The Alliance Commercial |
$3,088.00
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
KIT FLEXIMA NEPHROSTOMY CATHETER SYSTEM VTC 8F X 25CM M001271860
|
Facility
|
OP
|
$3,710.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2973046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,038.80 |
| Max. Negotiated Rate |
$14,840.00 |
| Rate for Payer: Aetna Commercial |
$3,339.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,190.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,038.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,411.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,855.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,780.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,966.30
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$3,413.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,076.12
|
| Rate for Payer: Health EOS Commercial |
$3,301.90
|
| Rate for Payer: HFN Commercial |
$3,413.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,782.50
|
| Rate for Payer: Multiplan Commercial |
$2,968.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,226.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,413.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,817.90
|
| Rate for Payer: Quartz Commercial |
$2,411.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,226.00
|
| Rate for Payer: The Alliance Commercial |
$14,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,040.50
|
| Rate for Payer: WPS Commercial |
$2,748.00
|
|
|
KIT FLEXIMA NEPHROSTOMY CATHETER SYSTEM VTC 8F X 25CM M001271860
|
Facility
|
IP
|
$3,710.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2973046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,817.90 |
| Max. Negotiated Rate |
$3,413.20 |
| Rate for Payer: Aetna Commercial |
$3,339.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,190.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,966.30
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$3,413.20
|
| Rate for Payer: Health EOS Commercial |
$3,301.90
|
| Rate for Payer: HFN Commercial |
$3,413.20
|
| Rate for Payer: Multiplan Commercial |
$2,968.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,226.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,413.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,817.90
|
| Rate for Payer: Quartz Commercial |
$2,226.00
|
| Rate for Payer: WEA Trust Commercial |
$2,040.50
|
| Rate for Payer: WPS Commercial |
$2,748.00
|
|
|
KIT FLEXI-SEAL FECAL ODOR CONTROL 418000
|
Facility
|
OP
|
$3,701.00
|
|
| Hospital Charge Code |
2963010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,036.28 |
| Max. Negotiated Rate |
$14,804.00 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,036.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,405.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,850.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,776.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,071.08
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,775.75
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,220.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,404.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,813.49
|
| Rate for Payer: Quartz Commercial |
$2,405.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,220.60
|
| Rate for Payer: The Alliance Commercial |
$14,804.00
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
