|
KIT FLEXI-SEAL FECAL ODOR CONTROL 418000
|
Facility
|
IP
|
$3,701.00
|
|
| Hospital Charge Code |
2963010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,813.49 |
| Max. Negotiated Rate |
$3,404.92 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| 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: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| 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 |
$2,220.60
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
KIT GILL BIOPSY BRUSH G15045
|
Facility
|
OP
|
$1,269.00
|
|
| Hospital Charge Code |
2965865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.32 |
| Max. Negotiated Rate |
$5,076.00 |
| Rate for Payer: Aetna Commercial |
$1,142.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.34
|
| Rate for Payer: Aetna Managed Medicare |
$355.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$824.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$609.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.57
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,167.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.13
|
| Rate for Payer: Health EOS Commercial |
$1,129.41
|
| Rate for Payer: HFN Commercial |
$1,167.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$951.75
|
| Rate for Payer: Multiplan Commercial |
$1,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$761.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.48
|
| Rate for Payer: Quartz Beloit One Network |
$621.81
|
| Rate for Payer: Quartz Commercial |
$824.85
|
| Rate for Payer: Quartz Medicare Advantage |
$761.40
|
| Rate for Payer: The Alliance Commercial |
$5,076.00
|
| Rate for Payer: WEA Trust Commercial |
$697.95
|
| Rate for Payer: WPS Commercial |
$939.95
|
|
|
KIT GILL BIOPSY BRUSH G15045
|
Facility
|
IP
|
$1,269.00
|
|
| Hospital Charge Code |
2965865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.81 |
| Max. Negotiated Rate |
$1,167.48 |
| Rate for Payer: Aetna Commercial |
$1,142.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.57
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,167.48
|
| Rate for Payer: Health EOS Commercial |
$1,129.41
|
| Rate for Payer: HFN Commercial |
$1,167.48
|
| Rate for Payer: Multiplan Commercial |
$1,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$761.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.48
|
| Rate for Payer: Quartz Beloit One Network |
$621.81
|
| Rate for Payer: Quartz Commercial |
$761.40
|
| Rate for Payer: WEA Trust Commercial |
$697.95
|
| Rate for Payer: WPS Commercial |
$939.95
|
|
|
KIT GOOSE NECK SNARE 25mm
|
Facility
|
IP
|
$3,539.00
|
|
| Hospital Charge Code |
2973398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,734.11 |
| Max. Negotiated Rate |
$3,255.88 |
| Rate for Payer: Aetna Commercial |
$3,185.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,043.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.67
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,255.88
|
| Rate for Payer: Health EOS Commercial |
$3,149.71
|
| Rate for Payer: HFN Commercial |
$3,255.88
|
| Rate for Payer: Multiplan Commercial |
$2,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,123.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,255.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.11
|
| Rate for Payer: Quartz Commercial |
$2,123.40
|
| Rate for Payer: WEA Trust Commercial |
$1,946.45
|
| Rate for Payer: WPS Commercial |
$2,621.34
|
|
|
KIT GOOSE NECK SNARE 25mm
|
Facility
|
OP
|
$3,539.00
|
|
| Hospital Charge Code |
2973398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$990.92 |
| Max. Negotiated Rate |
$14,156.00 |
| Rate for Payer: Aetna Commercial |
$3,185.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,043.54
|
| Rate for Payer: Aetna Managed Medicare |
$990.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,300.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,698.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.67
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,255.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,980.42
|
| Rate for Payer: Health EOS Commercial |
$3,149.71
|
| Rate for Payer: HFN Commercial |
$3,255.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,654.25
|
| Rate for Payer: Multiplan Commercial |
$2,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,123.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,255.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.11
|
| Rate for Payer: Quartz Commercial |
$2,300.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,123.40
|
| Rate for Payer: The Alliance Commercial |
$14,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,946.45
|
| Rate for Payer: WPS Commercial |
$2,621.34
|
|
|
KIT GROSHONG REPAIR DUAL 7740000
|
Facility
|
IP
|
$1,907.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.43 |
| Max. Negotiated Rate |
$1,754.44 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,144.20
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
KIT GROSHONG REPAIR DUAL 7740000
|
Facility
|
OP
|
$1,907.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.96 |
| Max. Negotiated Rate |
$7,628.00 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Aetna Managed Medicare |
$533.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,239.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$953.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.16
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,430.25
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,239.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.20
|
| Rate for Payer: The Alliance Commercial |
$7,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
KIT HIP ARTHROSCOPY MASTER DISPOSABLE WITH BLADE ARTHREX AR-6526S
|
Facility
|
OP
|
$5,130.00
|
|
| Hospital Charge Code |
5074892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$20,520.00 |
| Rate for Payer: Aetna Commercial |
$4,617.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,411.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,436.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,334.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,565.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,718.90
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna Commercial |
$4,719.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,870.75
|
| Rate for Payer: Health EOS Commercial |
$4,565.70
|
| Rate for Payer: HFN Commercial |
$4,719.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,847.50
|
| Rate for Payer: Multiplan Commercial |
$4,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,078.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,719.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,513.70
|
| Rate for Payer: Quartz Commercial |
$3,334.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,078.00
|
| Rate for Payer: The Alliance Commercial |
$20,520.00
|
| Rate for Payer: WEA Trust Commercial |
$2,821.50
|
| Rate for Payer: WPS Commercial |
$3,799.79
|
|
|
KIT HIP ARTHROSCOPY MASTER DISPOSABLE WITH BLADE ARTHREX AR-6526S
|
Facility
|
IP
|
$5,130.00
|
|
| Hospital Charge Code |
5074892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,513.70 |
| Max. Negotiated Rate |
$4,719.60 |
| Rate for Payer: Aetna Commercial |
$4,617.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,411.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,718.90
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna Commercial |
$4,719.60
|
| Rate for Payer: Health EOS Commercial |
$4,565.70
|
| Rate for Payer: HFN Commercial |
$4,719.60
|
| Rate for Payer: Multiplan Commercial |
$4,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,078.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,719.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,513.70
|
| Rate for Payer: Quartz Commercial |
$3,078.00
|
| Rate for Payer: WEA Trust Commercial |
$2,821.50
|
| Rate for Payer: WPS Commercial |
$3,799.79
|
|
|
KIT HOOK / TRIANGLE BLADE 3056-6
|
Facility
|
IP
|
$2,087.00
|
|
| Hospital Charge Code |
5611596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,022.63 |
| Max. Negotiated Rate |
$1,920.04 |
| Rate for Payer: Aetna Commercial |
$1,878.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,794.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,106.11
|
| Rate for Payer: Cash Price |
$626.10
|
| Rate for Payer: Cigna Commercial |
$1,920.04
|
| Rate for Payer: Health EOS Commercial |
$1,857.43
|
| Rate for Payer: HFN Commercial |
$1,920.04
|
| Rate for Payer: Multiplan Commercial |
$1,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,252.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,920.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,022.63
|
| Rate for Payer: Quartz Commercial |
$1,252.20
|
| Rate for Payer: WEA Trust Commercial |
$1,147.85
|
| Rate for Payer: WPS Commercial |
$1,545.84
|
|
|
KIT HOOK / TRIANGLE BLADE 3056-6
|
Facility
|
OP
|
$2,087.00
|
|
| Hospital Charge Code |
5611596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.36 |
| Max. Negotiated Rate |
$8,348.00 |
| Rate for Payer: Aetna Commercial |
$1,878.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,794.82
|
| Rate for Payer: Aetna Managed Medicare |
$584.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,356.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,043.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,001.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,106.11
|
| Rate for Payer: Cash Price |
$626.10
|
| Rate for Payer: Cigna Commercial |
$1,920.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,167.89
|
| Rate for Payer: Health EOS Commercial |
$1,857.43
|
| Rate for Payer: HFN Commercial |
$1,920.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.25
|
| Rate for Payer: Multiplan Commercial |
$1,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,252.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,920.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,022.63
|
| Rate for Payer: Quartz Commercial |
$1,356.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,252.20
|
| Rate for Payer: The Alliance Commercial |
$8,348.00
|
| Rate for Payer: WEA Trust Commercial |
$1,147.85
|
| Rate for Payer: WPS Commercial |
$1,545.84
|
|
|
KIT HTR 10MM STERILE 220-10-003
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
4520500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,330.00 |
| Max. Negotiated Rate |
$19,000.00 |
| Rate for Payer: Aetna Commercial |
$4,275.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,085.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,330.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,087.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,375.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,517.50
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,370.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,658.10
|
| Rate for Payer: Health EOS Commercial |
$4,227.50
|
| Rate for Payer: HFN Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,562.50
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,850.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,370.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,327.50
|
| Rate for Payer: Quartz Commercial |
$3,087.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,850.00
|
| Rate for Payer: The Alliance Commercial |
$19,000.00
|
| Rate for Payer: WEA Trust Commercial |
$2,612.50
|
| Rate for Payer: WPS Commercial |
$3,518.32
|
|
|
KIT HTR 10MM STERILE 220-10-003
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
4520500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,327.50 |
| Max. Negotiated Rate |
$4,370.00 |
| Rate for Payer: Aetna Commercial |
$4,275.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,085.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,517.50
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,370.00
|
| Rate for Payer: Health EOS Commercial |
$4,227.50
|
| Rate for Payer: HFN Commercial |
$4,370.00
|
| Rate for Payer: Multiplan Commercial |
$3,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,850.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,370.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,327.50
|
| Rate for Payer: Quartz Commercial |
$2,850.00
|
| Rate for Payer: WEA Trust Commercial |
$2,612.50
|
| Rate for Payer: WPS Commercial |
$3,518.32
|
|
|
KIT HTR 8MM STERILE 220-08-003
|
Facility
|
OP
|
$5,586.00
|
|
| Hospital Charge Code |
5107366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,564.08 |
| Max. Negotiated Rate |
$22,344.00 |
| Rate for Payer: Aetna Commercial |
$5,027.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,803.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,564.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,630.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,681.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,960.58
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,139.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,125.93
|
| Rate for Payer: Health EOS Commercial |
$4,971.54
|
| Rate for Payer: HFN Commercial |
$5,139.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,189.50
|
| Rate for Payer: Multiplan Commercial |
$4,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,351.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,139.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,737.14
|
| Rate for Payer: Quartz Commercial |
$3,630.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,351.60
|
| Rate for Payer: The Alliance Commercial |
$22,344.00
|
| Rate for Payer: WEA Trust Commercial |
$3,072.30
|
| Rate for Payer: WPS Commercial |
$4,137.55
|
|
|
KIT HTR 8MM STERILE 220-08-003
|
Facility
|
IP
|
$5,586.00
|
|
| Hospital Charge Code |
5107366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,737.14 |
| Max. Negotiated Rate |
$5,139.12 |
| Rate for Payer: Aetna Commercial |
$5,027.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,803.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,960.58
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,139.12
|
| Rate for Payer: Health EOS Commercial |
$4,971.54
|
| Rate for Payer: HFN Commercial |
$5,139.12
|
| Rate for Payer: Multiplan Commercial |
$4,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,351.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,139.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,737.14
|
| Rate for Payer: Quartz Commercial |
$3,351.60
|
| Rate for Payer: WEA Trust Commercial |
$3,072.30
|
| Rate for Payer: WPS Commercial |
$4,137.55
|
|
|
KIT INTERNAL JUGULAR PUNCTURE
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
2963414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$96.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.62
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$207.60
|
| Rate for Payer: The Alliance Commercial |
$1,384.00
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
KIT INTERNAL JUGULAR PUNCTURE
|
Facility
|
IP
|
$346.00
|
|
| Hospital Charge Code |
2963414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
KIT INTRODUCER JEJUNAL TUBE 10249
|
Facility
|
OP
|
$2,854.00
|
|
| Hospital Charge Code |
4520416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.12 |
| Max. Negotiated Rate |
$11,416.00 |
| Rate for Payer: Aetna Commercial |
$2,568.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,454.44
|
| Rate for Payer: Aetna Managed Medicare |
$799.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,855.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,427.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,512.62
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$2,625.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,597.10
|
| Rate for Payer: Health EOS Commercial |
$2,540.06
|
| Rate for Payer: HFN Commercial |
$2,625.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,140.50
|
| Rate for Payer: Multiplan Commercial |
$2,283.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,712.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,625.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,398.46
|
| Rate for Payer: Quartz Commercial |
$1,855.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,712.40
|
| Rate for Payer: The Alliance Commercial |
$11,416.00
|
| Rate for Payer: WEA Trust Commercial |
$1,569.70
|
| Rate for Payer: WPS Commercial |
$2,113.96
|
|
|
KIT INTRODUCER JEJUNAL TUBE 10249
|
Facility
|
IP
|
$2,854.00
|
|
| Hospital Charge Code |
4520416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,398.46 |
| Max. Negotiated Rate |
$2,625.68 |
| Rate for Payer: Aetna Commercial |
$2,568.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,454.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,512.62
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$2,625.68
|
| Rate for Payer: Health EOS Commercial |
$2,540.06
|
| Rate for Payer: HFN Commercial |
$2,625.68
|
| Rate for Payer: Multiplan Commercial |
$2,283.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,712.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,625.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,398.46
|
| Rate for Payer: Quartz Commercial |
$1,712.40
|
| Rate for Payer: WEA Trust Commercial |
$1,569.70
|
| Rate for Payer: WPS Commercial |
$2,113.96
|
|
|
KIT JEJUNAL MIC 22FR 45CM 7-10ML BALLOON 0250-22
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
4520415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
KIT JEJUNAL MIC 22FR 45CM 7-10ML BALLOON 0250-22
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
4520415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
KIT JOINT PREP KIT STERILE 9914PK01
|
Facility
|
OP
|
$2,572.00
|
|
| Hospital Charge Code |
6179802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.16 |
| Max. Negotiated Rate |
$10,288.00 |
| Rate for Payer: Aetna Commercial |
$2,314.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.92
|
| Rate for Payer: Aetna Managed Medicare |
$720.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,671.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,234.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.16
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,366.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,439.29
|
| Rate for Payer: Health EOS Commercial |
$2,289.08
|
| Rate for Payer: HFN Commercial |
$2,366.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,929.00
|
| Rate for Payer: Multiplan Commercial |
$2,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,543.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.28
|
| Rate for Payer: Quartz Commercial |
$1,671.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,543.20
|
| Rate for Payer: The Alliance Commercial |
$10,288.00
|
| Rate for Payer: WEA Trust Commercial |
$1,414.60
|
| Rate for Payer: WPS Commercial |
$1,905.08
|
|
|
KIT JOINT PREP KIT STERILE 9914PK01
|
Facility
|
IP
|
$2,572.00
|
|
| Hospital Charge Code |
6179802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.28 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$2,314.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.16
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,366.24
|
| Rate for Payer: Health EOS Commercial |
$2,289.08
|
| Rate for Payer: HFN Commercial |
$2,366.24
|
| Rate for Payer: Multiplan Commercial |
$2,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,543.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.28
|
| Rate for Payer: Quartz Commercial |
$1,543.20
|
| Rate for Payer: WEA Trust Commercial |
$1,414.60
|
| Rate for Payer: WPS Commercial |
$1,905.08
|
|
|
KIT JOINT TIGHT ROPE AR-2257
|
Facility
|
IP
|
$5,884.00
|
|
| Hospital Charge Code |
2964715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,883.16 |
| Max. Negotiated Rate |
$5,413.28 |
| Rate for Payer: Aetna Commercial |
$5,295.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,060.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,118.52
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$5,413.28
|
| Rate for Payer: Health EOS Commercial |
$5,236.76
|
| Rate for Payer: HFN Commercial |
$5,413.28
|
| Rate for Payer: Multiplan Commercial |
$4,707.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,530.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,413.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,883.16
|
| Rate for Payer: Quartz Commercial |
$3,530.40
|
| Rate for Payer: WEA Trust Commercial |
$3,236.20
|
| Rate for Payer: WPS Commercial |
$4,358.28
|
|
|
KIT JOINT TIGHT ROPE AR-2257
|
Facility
|
OP
|
$5,884.00
|
|
| Hospital Charge Code |
2964715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,647.52 |
| Max. Negotiated Rate |
$23,536.00 |
| Rate for Payer: Aetna Commercial |
$5,295.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,060.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,647.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,824.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,942.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,824.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,118.52
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$5,413.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,292.69
|
| Rate for Payer: Health EOS Commercial |
$5,236.76
|
| Rate for Payer: HFN Commercial |
$5,413.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,413.00
|
| Rate for Payer: Multiplan Commercial |
$4,707.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,530.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,413.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,883.16
|
| Rate for Payer: Quartz Commercial |
$3,824.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,530.40
|
| Rate for Payer: The Alliance Commercial |
$23,536.00
|
| Rate for Payer: WEA Trust Commercial |
$3,236.20
|
| Rate for Payer: WPS Commercial |
$4,358.28
|
|
