|
KIT MATERNITY LATEX FREE
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2963265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| 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: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
KIT MICRO-PUNCTURE 4FR 15 CM
|
Facility
|
IP
|
$5,796.00
|
|
| Hospital Charge Code |
2973606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,953.64 |
| Max. Negotiated Rate |
$5,545.61 |
| Rate for Payer: Aetna Commercial |
$5,425.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.76
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,545.61
|
| Rate for Payer: Health EOS Commercial |
$5,364.78
|
| Rate for Payer: HFN Commercial |
$5,545.61
|
| Rate for Payer: Multiplan Commercial |
$4,822.27
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.64
|
| Rate for Payer: Quartz Commercial |
$3,616.70
|
| Rate for Payer: WEA Trust Commercial |
$3,315.31
|
| Rate for Payer: WPS Commercial |
$4,464.66
|
|
|
KIT MICRO-PUNCTURE 4FR 15 CM
|
Facility
|
OP
|
$5,796.00
|
|
| Hospital Charge Code |
2973606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,687.80 |
| Max. Negotiated Rate |
$5,545.61 |
| Rate for Payer: Aetna Commercial |
$5,425.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,687.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,918.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,013.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,893.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.76
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,545.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,373.27
|
| Rate for Payer: Health EOS Commercial |
$5,364.78
|
| Rate for Payer: HFN Commercial |
$5,545.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,520.88
|
| Rate for Payer: Multiplan Commercial |
$4,822.27
|
| Rate for Payer: NAPHCARE Commercial |
$3,616.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.64
|
| Rate for Payer: Quartz Commercial |
$3,918.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,616.70
|
| Rate for Payer: The Alliance Commercial |
$3,013.92
|
| Rate for Payer: WEA Trust Commercial |
$3,315.31
|
| Rate for Payer: WPS Commercial |
$4,464.66
|
|
|
KIT MICROSMOOTH SLEEVE 8065750517
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
2964172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.81 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$507.94
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
KIT MICROSMOOTH SLEEVE 8065750517
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
2964172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.04 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Aetna Managed Medicare |
$237.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$550.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$423.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$406.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.75
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$634.92
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: NAPHCARE Commercial |
$507.94
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$550.26
|
| Rate for Payer: Quartz Medicare Advantage |
$507.94
|
| Rate for Payer: The Alliance Commercial |
$423.28
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
KIT MONOPTY BIOPSY 16 GA
|
Facility
|
OP
|
$1,238.00
|
|
| Hospital Charge Code |
2962993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.51 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$360.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$836.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$643.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$618.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.64
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$772.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$836.89
|
| Rate for Payer: Quartz Medicare Advantage |
$772.51
|
| Rate for Payer: The Alliance Commercial |
$643.76
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
KIT MONOPTY BIOPSY 16 GA
|
Facility
|
IP
|
$1,238.00
|
|
| Hospital Charge Code |
2962993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.88 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$772.51
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
KIT NANONEEDLE HIGH FLOW CT 125MM AR-3210-0052
|
Facility
|
IP
|
$2,355.00
|
|
| Hospital Charge Code |
6234126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.11 |
| Max. Negotiated Rate |
$2,253.26 |
| Rate for Payer: Aetna Commercial |
$2,204.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,106.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.08
|
| Rate for Payer: Cash Price |
$706.50
|
| Rate for Payer: Cigna Commercial |
$2,253.26
|
| Rate for Payer: Health EOS Commercial |
$2,179.79
|
| Rate for Payer: HFN Commercial |
$2,253.26
|
| Rate for Payer: Multiplan Commercial |
$1,959.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,253.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.11
|
| Rate for Payer: Quartz Commercial |
$1,469.52
|
| Rate for Payer: WEA Trust Commercial |
$1,347.06
|
| Rate for Payer: WPS Commercial |
$1,814.06
|
|
|
KIT NANONEEDLE HIGH FLOW CT 125MM AR-3210-0052
|
Facility
|
OP
|
$2,355.00
|
|
| Hospital Charge Code |
6234126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.78 |
| Max. Negotiated Rate |
$2,253.26 |
| Rate for Payer: Aetna Commercial |
$2,204.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,106.31
|
| Rate for Payer: Aetna Managed Medicare |
$685.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,591.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,224.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,175.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.08
|
| Rate for Payer: Cash Price |
$706.50
|
| Rate for Payer: Cigna Commercial |
$2,253.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,370.61
|
| Rate for Payer: Health EOS Commercial |
$2,179.79
|
| Rate for Payer: HFN Commercial |
$2,253.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,836.90
|
| Rate for Payer: Multiplan Commercial |
$1,959.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,469.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,253.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.11
|
| Rate for Payer: Quartz Commercial |
$1,591.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,469.52
|
| Rate for Payer: The Alliance Commercial |
$1,224.60
|
| Rate for Payer: WEA Trust Commercial |
$1,347.06
|
| Rate for Payer: WPS Commercial |
$1,814.06
|
|
|
KIT NEBULIZER AERONEB SOLO ADULT 06-AG-AS3350-US
|
Facility
|
OP
|
$811.00
|
|
| Hospital Charge Code |
4594778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.16 |
| Max. Negotiated Rate |
$775.96 |
| Rate for Payer: Aetna Commercial |
$759.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| Rate for Payer: Aetna Managed Medicare |
$236.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$548.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.02
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$775.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$472.00
|
| Rate for Payer: Health EOS Commercial |
$750.66
|
| Rate for Payer: HFN Commercial |
$775.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.58
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: NAPHCARE Commercial |
$506.06
|
| Rate for Payer: Preferred Network Access Commercial |
$775.96
|
| Rate for Payer: Quartz Beloit One Network |
$413.29
|
| Rate for Payer: Quartz Commercial |
$548.24
|
| Rate for Payer: Quartz Medicare Advantage |
$506.06
|
| Rate for Payer: The Alliance Commercial |
$421.72
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$624.71
|
|
|
KIT NEBULIZER AERONEB SOLO ADULT 06-AG-AS3350-US
|
Facility
|
IP
|
$811.00
|
|
| Hospital Charge Code |
4594778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.29 |
| Max. Negotiated Rate |
$775.96 |
| Rate for Payer: Aetna Commercial |
$759.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.02
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$775.96
|
| Rate for Payer: Health EOS Commercial |
$750.66
|
| Rate for Payer: HFN Commercial |
$775.96
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: Preferred Network Access Commercial |
$775.96
|
| Rate for Payer: Quartz Beloit One Network |
$413.29
|
| Rate for Payer: Quartz Commercial |
$506.06
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$624.71
|
|
|
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 |
$1,343.82 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,645.49
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
KIT NEPHROSTOMY 10.2FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17156
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5384649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$767.89 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Aetna Managed Medicare |
$767.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.73
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,056.86
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,782.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.49
|
| Rate for Payer: The Alliance Commercial |
$1,371.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
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 |
$803.13 |
| Max. Negotiated Rate |
$2,638.85 |
| Rate for Payer: Aetna Commercial |
$2,581.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.76
|
| Rate for Payer: Aetna Managed Medicare |
$803.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,376.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.21
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,638.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,605.16
|
| Rate for Payer: Health EOS Commercial |
$2,552.80
|
| Rate for Payer: HFN Commercial |
$2,638.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,151.24
|
| Rate for Payer: Multiplan Commercial |
$2,294.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,720.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.48
|
| Rate for Payer: Quartz Commercial |
$1,864.41
|
| Rate for Payer: Quartz Medicare Advantage |
$1,720.99
|
| Rate for Payer: The Alliance Commercial |
$1,434.16
|
| Rate for Payer: WEA Trust Commercial |
$1,577.58
|
| Rate for Payer: WPS Commercial |
$2,124.49
|
|
|
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 |
$1,405.48 |
| Max. Negotiated Rate |
$2,638.85 |
| Rate for Payer: Aetna Commercial |
$2,581.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.21
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,638.85
|
| Rate for Payer: Health EOS Commercial |
$2,552.80
|
| Rate for Payer: HFN Commercial |
$2,638.85
|
| Rate for Payer: Multiplan Commercial |
$2,294.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.48
|
| Rate for Payer: Quartz Commercial |
$1,720.99
|
| Rate for Payer: WEA Trust Commercial |
$1,577.58
|
| Rate for Payer: WPS Commercial |
$2,124.49
|
|
|
KIT NEVER TOUCH 65CM 11402002
|
Facility
|
IP
|
$5,433.00
|
|
| Hospital Charge Code |
2964098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,768.66 |
| Max. Negotiated Rate |
$5,198.29 |
| Rate for Payer: Aetna Commercial |
$5,085.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,859.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,994.67
|
| Rate for Payer: Cash Price |
$1,629.90
|
| Rate for Payer: Cigna Commercial |
$5,198.29
|
| Rate for Payer: Health EOS Commercial |
$5,028.78
|
| Rate for Payer: HFN Commercial |
$5,198.29
|
| Rate for Payer: Multiplan Commercial |
$4,520.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,198.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,768.66
|
| Rate for Payer: Quartz Commercial |
$3,390.19
|
| Rate for Payer: WEA Trust Commercial |
$3,107.68
|
| Rate for Payer: WPS Commercial |
$4,185.04
|
|
|
KIT NEVER TOUCH 65CM 11402002
|
Facility
|
OP
|
$5,433.00
|
|
| Hospital Charge Code |
2964098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,582.09 |
| Max. Negotiated Rate |
$5,198.29 |
| Rate for Payer: Aetna Commercial |
$5,085.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,859.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,672.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,825.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,712.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,994.67
|
| Rate for Payer: Cash Price |
$1,629.90
|
| Rate for Payer: Cigna Commercial |
$5,198.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,162.01
|
| Rate for Payer: Health EOS Commercial |
$5,028.78
|
| Rate for Payer: HFN Commercial |
$5,198.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,237.74
|
| Rate for Payer: Multiplan Commercial |
$4,520.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,390.19
|
| Rate for Payer: Preferred Network Access Commercial |
$5,198.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,768.66
|
| Rate for Payer: Quartz Commercial |
$3,672.71
|
| Rate for Payer: Quartz Medicare Advantage |
$3,390.19
|
| Rate for Payer: The Alliance Commercial |
$2,825.16
|
| Rate for Payer: WEA Trust Commercial |
$3,107.68
|
| Rate for Payer: WPS Commercial |
$4,185.04
|
|
|
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 |
$916.77 |
| Max. Negotiated Rate |
$1,721.28 |
| Rate for Payer: Aetna Commercial |
$1,683.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$991.61
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cigna Commercial |
$1,721.28
|
| Rate for Payer: Health EOS Commercial |
$1,665.15
|
| Rate for Payer: HFN Commercial |
$1,721.28
|
| Rate for Payer: Multiplan Commercial |
$1,496.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,721.28
|
| Rate for Payer: Quartz Beloit One Network |
$916.77
|
| Rate for Payer: Quartz Commercial |
$1,122.58
|
| Rate for Payer: WEA Trust Commercial |
$1,029.03
|
| Rate for Payer: WPS Commercial |
$1,385.77
|
|
|
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 |
$367.15 |
| Max. Negotiated Rate |
$1,721.28 |
| Rate for Payer: Aetna Commercial |
$1,683.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.03
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,216.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$935.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$898.06
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$991.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cigna Commercial |
$1,721.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,047.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,665.15
|
| Rate for Payer: HFN Commercial |
$1,721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,496.77
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,721.28
|
| Rate for Payer: Quartz Beloit One Network |
$916.77
|
| Rate for Payer: Quartz Commercial |
$1,216.12
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$1,029.03
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,385.77
|
|
|
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 |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
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 |
$367.15 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
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 |
$1,660.42 |
| Max. Negotiated Rate |
$5,455.67 |
| Rate for Payer: Aetna Commercial |
$5,337.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,099.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,660.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,854.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,965.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,846.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.94
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$5,455.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,318.56
|
| Rate for Payer: Health EOS Commercial |
$5,277.77
|
| Rate for Payer: HFN Commercial |
$5,455.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,447.56
|
| Rate for Payer: Multiplan Commercial |
$4,744.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,558.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,455.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.74
|
| Rate for Payer: Quartz Commercial |
$3,854.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,558.05
|
| Rate for Payer: The Alliance Commercial |
$2,965.04
|
| Rate for Payer: WEA Trust Commercial |
$3,261.54
|
| Rate for Payer: WPS Commercial |
$4,392.25
|
|
|
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 |
$2,905.74 |
| Max. Negotiated Rate |
$5,455.67 |
| Rate for Payer: Aetna Commercial |
$5,337.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,099.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.94
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$5,455.67
|
| Rate for Payer: Health EOS Commercial |
$5,277.77
|
| Rate for Payer: HFN Commercial |
$5,455.67
|
| Rate for Payer: Multiplan Commercial |
$4,744.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,455.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.74
|
| Rate for Payer: Quartz Commercial |
$3,558.05
|
| Rate for Payer: WEA Trust Commercial |
$3,261.54
|
| Rate for Payer: WPS Commercial |
$4,392.25
|
|
|
KIT PCNL PERCUTANEOUS TRACT WITH ZIPWIRE M0064501140
|
Facility
|
IP
|
$5,440.00
|
|
| Hospital Charge Code |
5306819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,772.22 |
| Max. Negotiated Rate |
$5,204.99 |
| Rate for Payer: Aetna Commercial |
$5,091.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.53
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$5,204.99
|
| Rate for Payer: Health EOS Commercial |
$5,035.26
|
| Rate for Payer: HFN Commercial |
$5,204.99
|
| Rate for Payer: Multiplan Commercial |
$4,526.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,772.22
|
| Rate for Payer: Quartz Commercial |
$3,394.56
|
| Rate for Payer: WEA Trust Commercial |
$3,111.68
|
| Rate for Payer: WPS Commercial |
$4,190.43
|
|
|
KIT PCNL PERCUTANEOUS TRACT WITH ZIPWIRE M0064501140
|
Facility
|
OP
|
$5,440.00
|
|
| Hospital Charge Code |
5306819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.13 |
| Max. Negotiated Rate |
$5,204.99 |
| Rate for Payer: Aetna Commercial |
$5,091.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,584.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,677.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,828.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,715.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.53
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$5,204.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,166.08
|
| Rate for Payer: Health EOS Commercial |
$5,035.26
|
| Rate for Payer: HFN Commercial |
$5,204.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,243.20
|
| Rate for Payer: Multiplan Commercial |
$4,526.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,394.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,772.22
|
| Rate for Payer: Quartz Commercial |
$3,677.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,394.56
|
| Rate for Payer: The Alliance Commercial |
$2,828.80
|
| Rate for Payer: WEA Trust Commercial |
$3,111.68
|
| Rate for Payer: WPS Commercial |
$4,190.43
|
|
