|
KIT HTR 8MM STERILE 220-08-003
|
Facility
|
IP
|
$5,586.00
|
|
| Hospital Charge Code |
5107366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,846.63 |
| Max. Negotiated Rate |
$5,344.68 |
| Rate for Payer: Aetna Commercial |
$5,228.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,079.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,344.68
|
| Rate for Payer: Health EOS Commercial |
$5,170.40
|
| Rate for Payer: HFN Commercial |
$5,344.68
|
| Rate for Payer: Multiplan Commercial |
$4,647.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.63
|
| Rate for Payer: Quartz Commercial |
$3,485.66
|
| Rate for Payer: WEA Trust Commercial |
$3,195.19
|
| Rate for Payer: WPS Commercial |
$4,302.90
|
|
|
KIT HTR 8MM STERILE 220-08-003
|
Facility
|
OP
|
$5,586.00
|
|
| Hospital Charge Code |
5107366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,626.64 |
| Max. Negotiated Rate |
$5,344.68 |
| Rate for Payer: Aetna Commercial |
$5,228.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,626.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,776.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,904.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,788.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,079.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,344.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,251.05
|
| Rate for Payer: Health EOS Commercial |
$5,170.40
|
| Rate for Payer: HFN Commercial |
$5,344.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,357.08
|
| Rate for Payer: Multiplan Commercial |
$4,647.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,485.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.63
|
| Rate for Payer: Quartz Commercial |
$3,776.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,485.66
|
| Rate for Payer: The Alliance Commercial |
$2,904.72
|
| Rate for Payer: WEA Trust Commercial |
$3,195.19
|
| Rate for Payer: WPS Commercial |
$4,302.90
|
|
|
KIT INTERNAL JUGULAR PUNCTURE
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
2963414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$100.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.37
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.88
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$215.90
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$233.90
|
| Rate for Payer: Quartz Medicare Advantage |
$215.90
|
| Rate for Payer: The Alliance Commercial |
$179.92
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
KIT INTERNAL JUGULAR PUNCTURE
|
Facility
|
IP
|
$346.00
|
|
| Hospital Charge Code |
2963414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$215.90
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
KIT INTRODUCER JEJUNAL TUBE 10249
|
Facility
|
OP
|
$2,854.00
|
|
| Hospital Charge Code |
4520416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.08 |
| Max. Negotiated Rate |
$2,730.71 |
| Rate for Payer: Aetna Commercial |
$2,671.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,552.62
|
| Rate for Payer: Aetna Managed Medicare |
$831.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,929.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,484.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,424.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.12
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$2,730.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,661.03
|
| Rate for Payer: Health EOS Commercial |
$2,641.66
|
| Rate for Payer: HFN Commercial |
$2,730.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,226.12
|
| Rate for Payer: Multiplan Commercial |
$2,374.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,780.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,730.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.40
|
| Rate for Payer: Quartz Commercial |
$1,929.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,780.90
|
| Rate for Payer: The Alliance Commercial |
$1,484.08
|
| Rate for Payer: WEA Trust Commercial |
$1,632.49
|
| Rate for Payer: WPS Commercial |
$2,198.44
|
|
|
KIT INTRODUCER JEJUNAL TUBE 10249
|
Facility
|
IP
|
$2,854.00
|
|
| Hospital Charge Code |
4520416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,454.40 |
| Max. Negotiated Rate |
$2,730.71 |
| Rate for Payer: Aetna Commercial |
$2,671.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,552.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.12
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$2,730.71
|
| Rate for Payer: Health EOS Commercial |
$2,641.66
|
| Rate for Payer: HFN Commercial |
$2,730.71
|
| Rate for Payer: Multiplan Commercial |
$2,374.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,730.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.40
|
| Rate for Payer: Quartz Commercial |
$1,780.90
|
| Rate for Payer: WEA Trust Commercial |
$1,632.49
|
| Rate for Payer: WPS Commercial |
$2,198.44
|
|
|
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 |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
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 |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
KIT JOINT PREP KIT STERILE 9914PK01
|
Facility
|
IP
|
$2,572.00
|
|
| Hospital Charge Code |
6179802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.69 |
| Max. Negotiated Rate |
$2,460.89 |
| Rate for Payer: Aetna Commercial |
$2,407.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,300.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.69
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,460.89
|
| Rate for Payer: Health EOS Commercial |
$2,380.64
|
| Rate for Payer: HFN Commercial |
$2,460.89
|
| Rate for Payer: Multiplan Commercial |
$2,139.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.69
|
| Rate for Payer: Quartz Commercial |
$1,604.93
|
| Rate for Payer: WEA Trust Commercial |
$1,471.18
|
| Rate for Payer: WPS Commercial |
$1,981.21
|
|
|
KIT JOINT PREP KIT STERILE 9914PK01
|
Facility
|
OP
|
$2,572.00
|
|
| Hospital Charge Code |
6179802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.97 |
| Max. Negotiated Rate |
$2,460.89 |
| Rate for Payer: Aetna Commercial |
$2,407.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,300.40
|
| Rate for Payer: Aetna Managed Medicare |
$748.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.69
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,460.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.90
|
| Rate for Payer: Health EOS Commercial |
$2,380.64
|
| Rate for Payer: HFN Commercial |
$2,460.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,006.16
|
| Rate for Payer: Multiplan Commercial |
$2,139.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.69
|
| Rate for Payer: Quartz Commercial |
$1,738.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.93
|
| Rate for Payer: The Alliance Commercial |
$1,337.44
|
| Rate for Payer: WEA Trust Commercial |
$1,471.18
|
| Rate for Payer: WPS Commercial |
$1,981.21
|
|
|
KIT JOINT TIGHT ROPE AR-2257
|
Facility
|
IP
|
$5,884.00
|
|
| Hospital Charge Code |
2964715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,998.49 |
| Max. Negotiated Rate |
$5,629.81 |
| Rate for Payer: Aetna Commercial |
$5,507.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,262.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,243.26
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$5,629.81
|
| Rate for Payer: Health EOS Commercial |
$5,446.23
|
| Rate for Payer: HFN Commercial |
$5,629.81
|
| Rate for Payer: Multiplan Commercial |
$4,895.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,629.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,998.49
|
| Rate for Payer: Quartz Commercial |
$3,671.62
|
| Rate for Payer: WEA Trust Commercial |
$3,365.65
|
| Rate for Payer: WPS Commercial |
$4,532.45
|
|
|
KIT JOINT TIGHT ROPE AR-2257
|
Facility
|
OP
|
$5,884.00
|
|
| Hospital Charge Code |
2964715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,713.42 |
| Max. Negotiated Rate |
$5,629.81 |
| Rate for Payer: Aetna Commercial |
$5,507.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,262.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,713.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,977.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,059.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,937.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,243.26
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$5,629.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,424.49
|
| Rate for Payer: Health EOS Commercial |
$5,446.23
|
| Rate for Payer: HFN Commercial |
$5,629.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,589.52
|
| Rate for Payer: Multiplan Commercial |
$4,895.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,671.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,629.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,998.49
|
| Rate for Payer: Quartz Commercial |
$3,977.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,671.62
|
| Rate for Payer: The Alliance Commercial |
$3,059.68
|
| Rate for Payer: WEA Trust Commercial |
$3,365.65
|
| Rate for Payer: WPS Commercial |
$4,532.45
|
|
|
KIT JUGGERKNOT 2.9MM DISPOSIBLE 912057
|
Facility
|
IP
|
$4,156.00
|
|
| Hospital Charge Code |
4519986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,117.90 |
| Max. Negotiated Rate |
$3,976.46 |
| Rate for Payer: Aetna Commercial |
$3,890.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,717.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,290.79
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$3,976.46
|
| Rate for Payer: Health EOS Commercial |
$3,846.79
|
| Rate for Payer: HFN Commercial |
$3,976.46
|
| Rate for Payer: Multiplan Commercial |
$3,457.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,976.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,117.90
|
| Rate for Payer: Quartz Commercial |
$2,593.34
|
| Rate for Payer: WEA Trust Commercial |
$2,377.23
|
| Rate for Payer: WPS Commercial |
$3,201.37
|
|
|
KIT JUGGERKNOT 2.9MM DISPOSIBLE 912057
|
Facility
|
OP
|
$4,156.00
|
|
| Hospital Charge Code |
4519986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,210.23 |
| Max. Negotiated Rate |
$3,976.46 |
| Rate for Payer: Aetna Commercial |
$3,890.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,717.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,809.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,161.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,074.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,290.79
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$3,976.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,418.79
|
| Rate for Payer: Health EOS Commercial |
$3,846.79
|
| Rate for Payer: HFN Commercial |
$3,976.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,241.68
|
| Rate for Payer: Multiplan Commercial |
$3,457.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,593.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,976.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,117.90
|
| Rate for Payer: Quartz Commercial |
$2,809.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,593.34
|
| Rate for Payer: The Alliance Commercial |
$2,161.12
|
| Rate for Payer: WEA Trust Commercial |
$2,377.23
|
| Rate for Payer: WPS Commercial |
$3,201.37
|
|
|
KIT JUJUNOSTOMY
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
2973679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
KIT JUJUNOSTOMY
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
2973679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.23 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
KIT LEAD INTERSTIM II SURESCAN MRI 4.32MM X 28CM (RECHARGE FREE) 978B128
|
Facility
|
IP
|
$24,223.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5603547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,344.04 |
| Max. Negotiated Rate |
$23,176.57 |
| Rate for Payer: Aetna Commercial |
$22,672.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,665.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,351.72
|
| Rate for Payer: Cash Price |
$7,266.90
|
| Rate for Payer: Cigna Commercial |
$23,176.57
|
| Rate for Payer: Health EOS Commercial |
$22,420.81
|
| Rate for Payer: HFN Commercial |
$23,176.57
|
| Rate for Payer: Multiplan Commercial |
$20,153.54
|
| Rate for Payer: Preferred Network Access Commercial |
$23,176.57
|
| Rate for Payer: Quartz Beloit One Network |
$12,344.04
|
| Rate for Payer: Quartz Commercial |
$15,115.15
|
| Rate for Payer: WEA Trust Commercial |
$13,855.56
|
| Rate for Payer: WPS Commercial |
$18,658.98
|
|
|
KIT LEAD INTERSTIM II SURESCAN MRI 4.32MM X 28CM (RECHARGE FREE) 978B128
|
Facility
|
OP
|
$24,223.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5603547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,053.74 |
| Max. Negotiated Rate |
$23,176.57 |
| Rate for Payer: Aetna Commercial |
$22,672.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,665.05
|
| Rate for Payer: Aetna Managed Medicare |
$7,053.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,595.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,092.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,351.72
|
| Rate for Payer: Cash Price |
$7,266.90
|
| Rate for Payer: Cigna Commercial |
$23,176.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,097.79
|
| Rate for Payer: Health EOS Commercial |
$22,420.81
|
| Rate for Payer: HFN Commercial |
$23,176.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,893.94
|
| Rate for Payer: Multiplan Commercial |
$20,153.54
|
| Rate for Payer: NAPHCARE Commercial |
$15,115.15
|
| Rate for Payer: Preferred Network Access Commercial |
$23,176.57
|
| Rate for Payer: Quartz Beloit One Network |
$12,344.04
|
| Rate for Payer: Quartz Commercial |
$16,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$15,115.15
|
| Rate for Payer: The Alliance Commercial |
$12,595.96
|
| Rate for Payer: WEA Trust Commercial |
$13,855.56
|
| Rate for Payer: WPS Commercial |
$18,658.98
|
|
|
KIT LEAD INTRODUCER INTERSTIM 3550-18
|
Facility
|
IP
|
$3,411.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5349491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,738.25 |
| Max. Negotiated Rate |
$3,263.64 |
| Rate for Payer: Aetna Commercial |
$3,192.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,050.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,880.14
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cigna Commercial |
$3,263.64
|
| Rate for Payer: Health EOS Commercial |
$3,157.22
|
| Rate for Payer: HFN Commercial |
$3,263.64
|
| Rate for Payer: Multiplan Commercial |
$2,837.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,738.25
|
| Rate for Payer: Quartz Commercial |
$2,128.46
|
| Rate for Payer: WEA Trust Commercial |
$1,951.09
|
| Rate for Payer: WPS Commercial |
$2,627.49
|
|
|
KIT LEAD INTRODUCER INTERSTIM 3550-18
|
Facility
|
OP
|
$3,411.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5349491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.28 |
| Max. Negotiated Rate |
$3,263.64 |
| Rate for Payer: Aetna Commercial |
$3,192.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,050.80
|
| Rate for Payer: Aetna Managed Medicare |
$993.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,305.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,773.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,702.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,880.14
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cigna Commercial |
$3,263.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,985.20
|
| Rate for Payer: Health EOS Commercial |
$3,157.22
|
| Rate for Payer: HFN Commercial |
$3,263.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,660.58
|
| Rate for Payer: Multiplan Commercial |
$2,837.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,128.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,738.25
|
| Rate for Payer: Quartz Commercial |
$2,305.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,128.46
|
| Rate for Payer: The Alliance Commercial |
$1,773.72
|
| Rate for Payer: WEA Trust Commercial |
$1,951.09
|
| Rate for Payer: WPS Commercial |
$2,627.49
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.4MM X 445MM & STONE CATCHER M0068403530
|
Facility
|
OP
|
$6,102.00
|
|
| Hospital Charge Code |
5804330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,776.90 |
| Max. Negotiated Rate |
$5,838.39 |
| Rate for Payer: Aetna Commercial |
$5,711.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,457.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,124.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,173.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,046.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,363.42
|
| Rate for Payer: Cash Price |
$1,830.60
|
| Rate for Payer: Cigna Commercial |
$5,838.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,551.36
|
| Rate for Payer: Health EOS Commercial |
$5,648.01
|
| Rate for Payer: HFN Commercial |
$5,838.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,759.56
|
| Rate for Payer: Multiplan Commercial |
$5,076.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,807.65
|
| Rate for Payer: Preferred Network Access Commercial |
$5,838.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,109.58
|
| Rate for Payer: Quartz Commercial |
$4,124.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,807.65
|
| Rate for Payer: The Alliance Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$3,490.34
|
| Rate for Payer: WPS Commercial |
$4,700.37
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.4MM X 445MM & STONE CATCHER M0068403530
|
Facility
|
IP
|
$6,102.00
|
|
| Hospital Charge Code |
5804330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,109.58 |
| Max. Negotiated Rate |
$5,838.39 |
| Rate for Payer: Aetna Commercial |
$5,711.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,457.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,363.42
|
| Rate for Payer: Cash Price |
$1,830.60
|
| Rate for Payer: Cigna Commercial |
$5,838.39
|
| Rate for Payer: Health EOS Commercial |
$5,648.01
|
| Rate for Payer: HFN Commercial |
$5,838.39
|
| Rate for Payer: Multiplan Commercial |
$5,076.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,838.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,109.58
|
| Rate for Payer: Quartz Commercial |
$3,807.65
|
| Rate for Payer: WEA Trust Commercial |
$3,490.34
|
| Rate for Payer: WPS Commercial |
$4,700.37
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.9MM X 440MM & STONE CATCHER M0068403550/M0068402980/M0068402940
|
Facility
|
OP
|
$7,899.00
|
|
| Hospital Charge Code |
5459256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,300.19 |
| Max. Negotiated Rate |
$7,557.76 |
| Rate for Payer: Aetna Commercial |
$7,393.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.93
|
| Rate for Payer: Cash Price |
$2,369.70
|
| Rate for Payer: Cigna Commercial |
$7,557.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.22
|
| Rate for Payer: Health EOS Commercial |
$7,311.31
|
| Rate for Payer: HFN Commercial |
$7,557.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.22
|
| Rate for Payer: Multiplan Commercial |
$6,571.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,928.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.33
|
| Rate for Payer: Quartz Commercial |
$5,339.72
|
| Rate for Payer: Quartz Medicare Advantage |
$4,928.98
|
| Rate for Payer: The Alliance Commercial |
$4,107.48
|
| Rate for Payer: WEA Trust Commercial |
$4,518.23
|
| Rate for Payer: WPS Commercial |
$6,084.60
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.9MM X 440MM & STONE CATCHER M0068403550/M0068402980/M0068402940
|
Facility
|
IP
|
$7,899.00
|
|
| Hospital Charge Code |
5459256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,025.33 |
| Max. Negotiated Rate |
$7,557.76 |
| Rate for Payer: Aetna Commercial |
$7,393.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.93
|
| Rate for Payer: Cash Price |
$2,369.70
|
| Rate for Payer: Cigna Commercial |
$7,557.76
|
| Rate for Payer: Health EOS Commercial |
$7,311.31
|
| Rate for Payer: HFN Commercial |
$7,557.76
|
| Rate for Payer: Multiplan Commercial |
$6,571.97
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.33
|
| Rate for Payer: Quartz Commercial |
$4,928.98
|
| Rate for Payer: WEA Trust Commercial |
$4,518.23
|
| Rate for Payer: WPS Commercial |
$6,084.60
|
|
|
KIT MATERNITY LATEX FREE
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2963265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
