|
KIT NEPHROSTOMY 10.2FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17156
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5384649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,292.13 |
| Max. Negotiated Rate |
$2,426.04 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,582.20
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
KIT NEPHROSTOMY 8.5FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17155
|
Facility
|
IP
|
$2,758.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5306821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,351.42 |
| Max. Negotiated Rate |
$2,537.36 |
| Rate for Payer: Aetna Commercial |
$2,482.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,371.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,461.74
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,537.36
|
| Rate for Payer: Health EOS Commercial |
$2,454.62
|
| Rate for Payer: HFN Commercial |
$2,537.36
|
| Rate for Payer: Multiplan Commercial |
$2,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,654.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,537.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,351.42
|
| Rate for Payer: Quartz Commercial |
$1,654.80
|
| Rate for Payer: WEA Trust Commercial |
$1,516.90
|
| Rate for Payer: WPS Commercial |
$2,042.85
|
|
|
KIT NEPHROSTOMY 8.5FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17155
|
Facility
|
OP
|
$2,758.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5306821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.24 |
| Max. Negotiated Rate |
$11,032.00 |
| Rate for Payer: Aetna Commercial |
$2,482.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,371.88
|
| Rate for Payer: Aetna Managed Medicare |
$772.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,792.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,323.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,461.74
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,537.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,543.38
|
| Rate for Payer: Health EOS Commercial |
$2,454.62
|
| Rate for Payer: HFN Commercial |
$2,537.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,068.50
|
| Rate for Payer: Multiplan Commercial |
$2,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,654.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,537.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,351.42
|
| Rate for Payer: Quartz Commercial |
$1,792.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,654.80
|
| Rate for Payer: The Alliance Commercial |
$11,032.00
|
| Rate for Payer: WEA Trust Commercial |
$1,516.90
|
| Rate for Payer: WPS Commercial |
$2,042.85
|
|
|
KIT NEVER TOUCH 65CM 11402002
|
Facility
|
IP
|
$5,433.00
|
|
| Hospital Charge Code |
2964098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,662.17 |
| Max. Negotiated Rate |
$4,998.36 |
| Rate for Payer: Aetna Commercial |
$4,889.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,672.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,879.49
|
| Rate for Payer: Cash Price |
$1,629.90
|
| Rate for Payer: Cigna Commercial |
$4,998.36
|
| Rate for Payer: Health EOS Commercial |
$4,835.37
|
| Rate for Payer: HFN Commercial |
$4,998.36
|
| Rate for Payer: Multiplan Commercial |
$4,346.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,259.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,998.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,662.17
|
| Rate for Payer: Quartz Commercial |
$3,259.80
|
| Rate for Payer: WEA Trust Commercial |
$2,988.15
|
| Rate for Payer: WPS Commercial |
$4,024.22
|
|
|
KIT NEVER TOUCH 65CM 11402002
|
Facility
|
OP
|
$5,433.00
|
|
| Hospital Charge Code |
2964098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,521.24 |
| Max. Negotiated Rate |
$21,732.00 |
| Rate for Payer: Aetna Commercial |
$4,889.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,672.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,521.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,531.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,716.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,607.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,879.49
|
| Rate for Payer: Cash Price |
$1,629.90
|
| Rate for Payer: Cigna Commercial |
$4,998.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,040.31
|
| Rate for Payer: Health EOS Commercial |
$4,835.37
|
| Rate for Payer: HFN Commercial |
$4,998.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,074.75
|
| Rate for Payer: Multiplan Commercial |
$4,346.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,259.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,998.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,662.17
|
| Rate for Payer: Quartz Commercial |
$3,531.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,259.80
|
| Rate for Payer: The Alliance Commercial |
$21,732.00
|
| Rate for Payer: WEA Trust Commercial |
$2,988.15
|
| Rate for Payer: WPS Commercial |
$4,024.22
|
|
|
KIT NOVADAQ PINPOINT PAQ PP9036
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5074901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$881.51 |
| Max. Negotiated Rate |
$1,655.08 |
| Rate for Payer: Aetna Commercial |
$1,619.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,547.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$953.47
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cigna Commercial |
$1,655.08
|
| Rate for Payer: Health EOS Commercial |
$1,601.11
|
| Rate for Payer: HFN Commercial |
$1,655.08
|
| Rate for Payer: Multiplan Commercial |
$1,439.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,079.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,655.08
|
| Rate for Payer: Quartz Beloit One Network |
$881.51
|
| Rate for Payer: Quartz Commercial |
$1,079.40
|
| Rate for Payer: WEA Trust Commercial |
$989.45
|
| Rate for Payer: WPS Commercial |
$1,332.52
|
|
|
KIT NOVADAQ PINPOINT PAQ PP9036
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5074901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$1,655.08 |
| Rate for Payer: Aetna Commercial |
$1,619.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,547.14
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,169.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$899.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$863.52
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$953.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cigna Commercial |
$1,655.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,006.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,601.11
|
| Rate for Payer: HFN Commercial |
$1,655.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$1,439.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,655.08
|
| Rate for Payer: Quartz Beloit One Network |
$881.51
|
| Rate for Payer: Quartz Commercial |
$1,169.35
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$989.45
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$1,332.52
|
|
|
KIT NOVADAQ SPY PHI WITH INDOCYANINE GREEN/DRAPE HH9006
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5496799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$1,440.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.00
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,472.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,424.00
|
| Rate for Payer: HFN Commercial |
$1,472.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.00
|
| Rate for Payer: Quartz Beloit One Network |
$784.00
|
| Rate for Payer: Quartz Commercial |
$1,040.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$880.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$1,185.12
|
|
|
KIT NOVADAQ SPY PHI WITH INDOCYANINE GREEN/DRAPE HH9006
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5496799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$1,440.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,472.00
|
| Rate for Payer: Health EOS Commercial |
$1,424.00
|
| Rate for Payer: HFN Commercial |
$1,472.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: NAPHCARE Commercial |
$960.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.00
|
| Rate for Payer: Quartz Beloit One Network |
$784.00
|
| Rate for Payer: Quartz Commercial |
$960.00
|
| Rate for Payer: WEA Trust Commercial |
$880.00
|
| Rate for Payer: WPS Commercial |
$1,185.12
|
|
|
KIT PARS SUTURE IMPLANT AR-8860DS
|
Facility
|
IP
|
$5,702.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,793.98 |
| Max. Negotiated Rate |
$5,245.84 |
| Rate for Payer: Aetna Commercial |
$5,131.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,903.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,022.06
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$5,245.84
|
| Rate for Payer: Health EOS Commercial |
$5,074.78
|
| Rate for Payer: HFN Commercial |
$5,245.84
|
| Rate for Payer: Multiplan Commercial |
$4,561.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,245.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,793.98
|
| Rate for Payer: Quartz Commercial |
$3,421.20
|
| Rate for Payer: WEA Trust Commercial |
$3,136.10
|
| Rate for Payer: WPS Commercial |
$4,223.47
|
|
|
KIT PARS SUTURE IMPLANT AR-8860DS
|
Facility
|
OP
|
$5,702.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.56 |
| Max. Negotiated Rate |
$22,808.00 |
| Rate for Payer: Aetna Commercial |
$5,131.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,903.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,596.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,706.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,851.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,736.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,022.06
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$5,245.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,190.84
|
| Rate for Payer: Health EOS Commercial |
$5,074.78
|
| Rate for Payer: HFN Commercial |
$5,245.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,276.50
|
| Rate for Payer: Multiplan Commercial |
$4,561.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,245.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,793.98
|
| Rate for Payer: Quartz Commercial |
$3,706.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,421.20
|
| Rate for Payer: The Alliance Commercial |
$22,808.00
|
| Rate for Payer: WEA Trust Commercial |
$3,136.10
|
| Rate for Payer: WPS Commercial |
$4,223.47
|
|
|
KIT PCNL PERCUTANEOUS TRACT WITH ZIPWIRE M0064501140
|
Facility
|
IP
|
$5,440.00
|
|
| Hospital Charge Code |
5306819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,665.60 |
| Max. Negotiated Rate |
$5,004.80 |
| Rate for Payer: Aetna Commercial |
$4,896.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,678.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,883.20
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$5,004.80
|
| Rate for Payer: Health EOS Commercial |
$4,841.60
|
| Rate for Payer: HFN Commercial |
$5,004.80
|
| Rate for Payer: Multiplan Commercial |
$4,352.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,004.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,665.60
|
| Rate for Payer: Quartz Commercial |
$3,264.00
|
| Rate for Payer: WEA Trust Commercial |
$2,992.00
|
| Rate for Payer: WPS Commercial |
$4,029.41
|
|
|
KIT PCNL PERCUTANEOUS TRACT WITH ZIPWIRE M0064501140
|
Facility
|
OP
|
$5,440.00
|
|
| Hospital Charge Code |
5306819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,523.20 |
| Max. Negotiated Rate |
$21,760.00 |
| Rate for Payer: Aetna Commercial |
$4,896.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,678.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,523.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,536.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,720.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,611.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,883.20
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$5,004.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,044.22
|
| Rate for Payer: Health EOS Commercial |
$4,841.60
|
| Rate for Payer: HFN Commercial |
$5,004.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,080.00
|
| Rate for Payer: Multiplan Commercial |
$4,352.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,004.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,665.60
|
| Rate for Payer: Quartz Commercial |
$3,536.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,264.00
|
| Rate for Payer: The Alliance Commercial |
$21,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,992.00
|
| Rate for Payer: WPS Commercial |
$4,029.41
|
|
|
KIT PD CATHETER PRE-STERNAL 8888121132
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
4520281
|
|
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 PD CATHETER PRE-STERNAL 8888121132
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
4520281
|
|
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 PERC INSERT FOR 3.0 KNOTLESS ST AR-1938PK
|
Facility
|
OP
|
$3,897.00
|
|
| Hospital Charge Code |
5611599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,091.16 |
| Max. Negotiated Rate |
$15,588.00 |
| Rate for Payer: Aetna Commercial |
$3,507.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,351.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,091.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,533.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,948.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,870.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,065.41
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,585.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,180.76
|
| Rate for Payer: Health EOS Commercial |
$3,468.33
|
| Rate for Payer: HFN Commercial |
$3,585.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,922.75
|
| Rate for Payer: Multiplan Commercial |
$3,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,338.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,585.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,909.53
|
| Rate for Payer: Quartz Commercial |
$2,533.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,338.20
|
| Rate for Payer: The Alliance Commercial |
$15,588.00
|
| Rate for Payer: WEA Trust Commercial |
$2,143.35
|
| Rate for Payer: WPS Commercial |
$2,886.51
|
|
|
KIT PERC INSERT FOR 3.0 KNOTLESS ST AR-1938PK
|
Facility
|
IP
|
$3,897.00
|
|
| Hospital Charge Code |
5611599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,909.53 |
| Max. Negotiated Rate |
$3,585.24 |
| Rate for Payer: Aetna Commercial |
$3,507.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,351.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,065.41
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,585.24
|
| Rate for Payer: Health EOS Commercial |
$3,468.33
|
| Rate for Payer: HFN Commercial |
$3,585.24
|
| Rate for Payer: Multiplan Commercial |
$3,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,338.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,585.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,909.53
|
| Rate for Payer: Quartz Commercial |
$2,338.20
|
| Rate for Payer: WEA Trust Commercial |
$2,143.35
|
| Rate for Payer: WPS Commercial |
$2,886.51
|
|
|
KIT PERCUTANEOUS EXTENSION INTERSTIM SURESCAN MRI (RECHARGE FREE) 3560022
|
Facility
|
IP
|
$2,557.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
5603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.93 |
| Max. Negotiated Rate |
$2,352.44 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,534.20
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
KIT PERCUTANEOUS EXTENSION INTERSTIM SURESCAN MRI (RECHARGE FREE) 3560022
|
Facility
|
OP
|
$2,557.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
5603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.96 |
| Max. Negotiated Rate |
$10,228.00 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Aetna Managed Medicare |
$715.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,662.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.90
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,662.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,534.20
|
| Rate for Payer: The Alliance Commercial |
$10,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
KIT PERCUTANEOUS SHEATH 8.5fr AK-09803
|
Facility
|
OP
|
$547.00
|
|
| Hospital Charge Code |
2962966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$153.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.10
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$328.20
|
| Rate for Payer: The Alliance Commercial |
$2,188.00
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
KIT PERCUTANEOUS SHEATH 8.5fr AK-09803
|
Facility
|
IP
|
$547.00
|
|
| Hospital Charge Code |
2962966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.03 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$328.20
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
KIT PERICARDIAL CENTISIS 8.3FR #M00443051***DISC 3/23
|
Facility
|
IP
|
$2,338.00
|
|
| Hospital Charge Code |
2973600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,145.62 |
| Max. Negotiated Rate |
$2,150.96 |
| Rate for Payer: Aetna Commercial |
$2,104.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,010.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,239.14
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cigna Commercial |
$2,150.96
|
| Rate for Payer: Health EOS Commercial |
$2,080.82
|
| Rate for Payer: HFN Commercial |
$2,150.96
|
| Rate for Payer: Multiplan Commercial |
$1,870.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,402.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,150.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.62
|
| Rate for Payer: Quartz Commercial |
$1,402.80
|
| Rate for Payer: WEA Trust Commercial |
$1,285.90
|
| Rate for Payer: WPS Commercial |
$1,731.76
|
|
|
KIT PERICARDIAL CENTISIS 8.3FR #M00443051***DISC 3/23
|
Facility
|
OP
|
$2,338.00
|
|
| Hospital Charge Code |
2973600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$654.64 |
| Max. Negotiated Rate |
$9,352.00 |
| Rate for Payer: Aetna Commercial |
$2,104.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,010.68
|
| Rate for Payer: Aetna Managed Medicare |
$654.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,519.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,169.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,122.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,239.14
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cigna Commercial |
$2,150.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,308.34
|
| Rate for Payer: Health EOS Commercial |
$2,080.82
|
| Rate for Payer: HFN Commercial |
$2,150.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,753.50
|
| Rate for Payer: Multiplan Commercial |
$1,870.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,402.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,150.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.62
|
| Rate for Payer: Quartz Commercial |
$1,519.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,402.80
|
| Rate for Payer: The Alliance Commercial |
$9,352.00
|
| Rate for Payer: WEA Trust Commercial |
$1,285.90
|
| Rate for Payer: WPS Commercial |
$1,731.76
|
|
|
KIT PERI PATCH REPAIR #8888285001
|
Facility
|
IP
|
$1,119.00
|
|
| Hospital Charge Code |
2974668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.31 |
| Max. Negotiated Rate |
$1,029.48 |
| Rate for Payer: Aetna Commercial |
$1,007.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.07
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,029.48
|
| Rate for Payer: Health EOS Commercial |
$995.91
|
| Rate for Payer: HFN Commercial |
$1,029.48
|
| Rate for Payer: Multiplan Commercial |
$895.20
|
| Rate for Payer: NAPHCARE Commercial |
$671.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.48
|
| Rate for Payer: Quartz Beloit One Network |
$548.31
|
| Rate for Payer: Quartz Commercial |
$671.40
|
| Rate for Payer: WEA Trust Commercial |
$615.45
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
|
KIT PERI PATCH REPAIR #8888285001
|
Facility
|
OP
|
$1,119.00
|
|
| Hospital Charge Code |
2974668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$1,007.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.34
|
| Rate for Payer: Aetna Managed Medicare |
$313.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$727.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$559.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$537.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.07
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,029.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$626.19
|
| Rate for Payer: Health EOS Commercial |
$995.91
|
| Rate for Payer: HFN Commercial |
$1,029.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$839.25
|
| Rate for Payer: Multiplan Commercial |
$895.20
|
| Rate for Payer: NAPHCARE Commercial |
$671.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.48
|
| Rate for Payer: Quartz Beloit One Network |
$548.31
|
| Rate for Payer: Quartz Commercial |
$727.35
|
| Rate for Payer: Quartz Medicare Advantage |
$671.40
|
| Rate for Payer: The Alliance Commercial |
$4,476.00
|
| Rate for Payer: WEA Trust Commercial |
$615.45
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
