|
KIT PERITONEAL LAVAGE-ARROW
|
Facility
|
IP
|
$693.00
|
|
| Hospital Charge Code |
2962994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.57 |
| Max. Negotiated Rate |
$637.56 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.29
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$637.56
|
| Rate for Payer: Health EOS Commercial |
$616.77
|
| Rate for Payer: HFN Commercial |
$637.56
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: NAPHCARE Commercial |
$415.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.56
|
| Rate for Payer: Quartz Beloit One Network |
$339.57
|
| Rate for Payer: Quartz Commercial |
$415.80
|
| Rate for Payer: WEA Trust Commercial |
$381.15
|
| Rate for Payer: WPS Commercial |
$513.31
|
|
|
KIT PERITONEAL LAVAGE-ARROW
|
Facility
|
OP
|
$693.00
|
|
| Hospital Charge Code |
2962994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$2,772.00 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.98
|
| Rate for Payer: Aetna Managed Medicare |
$194.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.29
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$637.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.80
|
| Rate for Payer: Health EOS Commercial |
$616.77
|
| Rate for Payer: HFN Commercial |
$637.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.75
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: NAPHCARE Commercial |
$415.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.56
|
| Rate for Payer: Quartz Beloit One Network |
$339.57
|
| Rate for Payer: Quartz Commercial |
$450.45
|
| Rate for Payer: Quartz Medicare Advantage |
$415.80
|
| Rate for Payer: The Alliance Commercial |
$2,772.00
|
| Rate for Payer: WEA Trust Commercial |
$381.15
|
| Rate for Payer: WPS Commercial |
$513.31
|
|
|
KIT PNEUMOTHORAX
|
Facility
|
OP
|
$1,415.00
|
|
| Hospital Charge Code |
2962928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.20 |
| Max. Negotiated Rate |
$5,660.00 |
| Rate for Payer: Aetna Commercial |
$1,273.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,216.90
|
| Rate for Payer: Aetna Managed Medicare |
$396.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$919.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$707.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$749.95
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$1,301.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$791.83
|
| Rate for Payer: Health EOS Commercial |
$1,259.35
|
| Rate for Payer: HFN Commercial |
$1,301.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.25
|
| Rate for Payer: Multiplan Commercial |
$1,132.00
|
| Rate for Payer: NAPHCARE Commercial |
$849.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,301.80
|
| Rate for Payer: Quartz Beloit One Network |
$693.35
|
| Rate for Payer: Quartz Commercial |
$919.75
|
| Rate for Payer: Quartz Medicare Advantage |
$849.00
|
| Rate for Payer: The Alliance Commercial |
$5,660.00
|
| Rate for Payer: WEA Trust Commercial |
$778.25
|
| Rate for Payer: WPS Commercial |
$1,048.09
|
|
|
KIT PNEUMOTHORAX
|
Facility
|
IP
|
$1,415.00
|
|
| Hospital Charge Code |
2962928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.35 |
| Max. Negotiated Rate |
$1,301.80 |
| Rate for Payer: Aetna Commercial |
$1,273.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,216.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$749.95
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$1,301.80
|
| Rate for Payer: Health EOS Commercial |
$1,259.35
|
| Rate for Payer: HFN Commercial |
$1,301.80
|
| Rate for Payer: Multiplan Commercial |
$1,132.00
|
| Rate for Payer: NAPHCARE Commercial |
$849.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,301.80
|
| Rate for Payer: Quartz Beloit One Network |
$693.35
|
| Rate for Payer: Quartz Commercial |
$849.00
|
| Rate for Payer: WEA Trust Commercial |
$778.25
|
| Rate for Payer: WPS Commercial |
$1,048.09
|
|
|
KIT PORT ACCESS 20GX.1 2652010"
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
4508808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 20GX.1 2652010"
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
4508808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 20GX.1.5 2652015"
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
4508810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 20GX.1.5 2652015"
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
4508810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 20GX.75 2652034"
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
4508806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 20GX.75 2652034"
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
4508806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 22GX.1 2652210"
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
4508809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 22GX.1 2652210"
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
4508809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 22GX.75 2652234"
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
4508807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PORT ACCESS 22GX.75 2652234"
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
4508807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
KIT PRO-TOE VO DISP 4571-0500
|
Facility
|
OP
|
$3,172.00
|
|
| Hospital Charge Code |
3072447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.16 |
| Max. Negotiated Rate |
$12,688.00 |
| Rate for Payer: Aetna Commercial |
$2,854.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Aetna Managed Medicare |
$888.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,681.16
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$2,918.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,775.05
|
| Rate for Payer: Health EOS Commercial |
$2,823.08
|
| Rate for Payer: HFN Commercial |
$2,918.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,379.00
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,918.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.28
|
| Rate for Payer: Quartz Commercial |
$2,061.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,903.20
|
| Rate for Payer: The Alliance Commercial |
$12,688.00
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.50
|
|
|
KIT PRO-TOE VO DISP 4571-0500
|
Facility
|
IP
|
$3,172.00
|
|
| Hospital Charge Code |
3072447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,554.28 |
| Max. Negotiated Rate |
$2,918.24 |
| Rate for Payer: Aetna Commercial |
$2,854.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,681.16
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$2,918.24
|
| Rate for Payer: Health EOS Commercial |
$2,823.08
|
| Rate for Payer: HFN Commercial |
$2,918.24
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,918.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.28
|
| Rate for Payer: Quartz Commercial |
$1,903.20
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.50
|
|
|
KIT QUADRIPOLAR LEAD INTERSTIM 3889-28
|
Facility
|
OP
|
$21,647.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5349492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,061.16 |
| Max. Negotiated Rate |
$86,588.00 |
| Rate for Payer: Aetna Commercial |
$19,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,616.42
|
| Rate for Payer: Aetna Managed Medicare |
$6,061.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,390.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,472.91
|
| Rate for Payer: Cash Price |
$6,494.10
|
| Rate for Payer: Cigna Commercial |
$19,915.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,113.66
|
| Rate for Payer: Health EOS Commercial |
$19,265.83
|
| Rate for Payer: HFN Commercial |
$19,915.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,235.25
|
| Rate for Payer: Multiplan Commercial |
$17,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$19,915.24
|
| Rate for Payer: Quartz Beloit One Network |
$10,607.03
|
| Rate for Payer: Quartz Commercial |
$14,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$12,988.20
|
| Rate for Payer: The Alliance Commercial |
$86,588.00
|
| Rate for Payer: WEA Trust Commercial |
$11,905.85
|
| Rate for Payer: WPS Commercial |
$16,033.93
|
|
|
KIT QUADRIPOLAR LEAD INTERSTIM 3889-28
|
Facility
|
IP
|
$21,647.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5349492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,607.03 |
| Max. Negotiated Rate |
$19,915.24 |
| Rate for Payer: Aetna Commercial |
$19,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,616.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,472.91
|
| Rate for Payer: Cash Price |
$6,494.10
|
| Rate for Payer: Cigna Commercial |
$19,915.24
|
| Rate for Payer: Health EOS Commercial |
$19,265.83
|
| Rate for Payer: HFN Commercial |
$19,915.24
|
| Rate for Payer: Multiplan Commercial |
$17,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$19,915.24
|
| Rate for Payer: Quartz Beloit One Network |
$10,607.03
|
| Rate for Payer: Quartz Commercial |
$12,988.20
|
| Rate for Payer: WEA Trust Commercial |
$11,905.85
|
| Rate for Payer: WPS Commercial |
$16,033.93
|
|
|
KIT QUICKSET ARTHREX INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 5CC ABS-3005
|
Facility
|
IP
|
$12,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5521095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,192.13 |
| Max. Negotiated Rate |
$11,626.04 |
| Rate for Payer: Aetna Commercial |
$11,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,867.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,697.61
|
| Rate for Payer: Cash Price |
$3,791.10
|
| Rate for Payer: Cigna Commercial |
$11,626.04
|
| Rate for Payer: Health EOS Commercial |
$11,246.93
|
| Rate for Payer: HFN Commercial |
$11,626.04
|
| Rate for Payer: Multiplan Commercial |
$10,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,626.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,192.13
|
| Rate for Payer: Quartz Commercial |
$7,582.20
|
| Rate for Payer: WEA Trust Commercial |
$6,950.35
|
| Rate for Payer: WPS Commercial |
$9,360.23
|
|
|
KIT QUICKSET ARTHREX INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 5CC ABS-3005
|
Facility
|
OP
|
$12,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5521095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.36 |
| Max. Negotiated Rate |
$50,548.00 |
| Rate for Payer: Aetna Commercial |
$11,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,867.82
|
| Rate for Payer: Aetna Managed Medicare |
$3,538.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,214.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,318.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,065.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,697.61
|
| Rate for Payer: Cash Price |
$3,791.10
|
| Rate for Payer: Cigna Commercial |
$11,626.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,071.67
|
| Rate for Payer: Health EOS Commercial |
$11,246.93
|
| Rate for Payer: HFN Commercial |
$11,626.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,477.75
|
| Rate for Payer: Multiplan Commercial |
$10,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,626.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,192.13
|
| Rate for Payer: Quartz Commercial |
$8,214.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,582.20
|
| Rate for Payer: The Alliance Commercial |
$50,548.00
|
| Rate for Payer: WEA Trust Commercial |
$6,950.35
|
| Rate for Payer: WPS Commercial |
$9,360.23
|
|
|
KIT RECHARGER INTERSTIM WIRELESS RS5200
|
Facility
|
OP
|
$7,181.00
|
|
| Hospital Charge Code |
5603555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,010.68 |
| Max. Negotiated Rate |
$28,724.00 |
| Rate for Payer: Aetna Commercial |
$6,462.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,175.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,010.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,667.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,590.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,446.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,805.93
|
| Rate for Payer: Cash Price |
$2,154.30
|
| Rate for Payer: Cigna Commercial |
$6,606.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,018.49
|
| Rate for Payer: Health EOS Commercial |
$6,391.09
|
| Rate for Payer: HFN Commercial |
$6,606.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,385.75
|
| Rate for Payer: Multiplan Commercial |
$5,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,308.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,606.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.69
|
| Rate for Payer: Quartz Commercial |
$4,667.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,308.60
|
| Rate for Payer: The Alliance Commercial |
$28,724.00
|
| Rate for Payer: WEA Trust Commercial |
$3,949.55
|
| Rate for Payer: WPS Commercial |
$5,318.97
|
|
|
KIT RECHARGER INTERSTIM WIRELESS RS5200
|
Facility
|
IP
|
$7,181.00
|
|
| Hospital Charge Code |
5603555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,518.69 |
| Max. Negotiated Rate |
$6,606.52 |
| Rate for Payer: Aetna Commercial |
$6,462.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,175.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,805.93
|
| Rate for Payer: Cash Price |
$2,154.30
|
| Rate for Payer: Cigna Commercial |
$6,606.52
|
| Rate for Payer: Health EOS Commercial |
$6,391.09
|
| Rate for Payer: HFN Commercial |
$6,606.52
|
| Rate for Payer: Multiplan Commercial |
$5,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,308.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,606.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.69
|
| Rate for Payer: Quartz Commercial |
$4,308.60
|
| Rate for Payer: WEA Trust Commercial |
$3,949.55
|
| Rate for Payer: WPS Commercial |
$5,318.97
|
|
|
KIT REPAIR CATHETER 5587000
|
Facility
|
OP
|
$4,610.00
|
|
| Hospital Charge Code |
3098295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,290.80 |
| Max. Negotiated Rate |
$18,440.00 |
| Rate for Payer: Aetna Commercial |
$4,149.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,964.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,290.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,996.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,212.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,443.30
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$4,241.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,579.76
|
| Rate for Payer: Health EOS Commercial |
$4,102.90
|
| Rate for Payer: HFN Commercial |
$4,241.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,457.50
|
| Rate for Payer: Multiplan Commercial |
$3,688.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,766.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,241.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,258.90
|
| Rate for Payer: Quartz Commercial |
$2,996.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,766.00
|
| Rate for Payer: The Alliance Commercial |
$18,440.00
|
| Rate for Payer: WEA Trust Commercial |
$2,535.50
|
| Rate for Payer: WPS Commercial |
$3,414.63
|
|
|
KIT REPAIR CATHETER 5587000
|
Facility
|
IP
|
$4,610.00
|
|
| Hospital Charge Code |
3098295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,258.90 |
| Max. Negotiated Rate |
$4,241.20 |
| Rate for Payer: Aetna Commercial |
$4,149.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,964.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,443.30
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$4,241.20
|
| Rate for Payer: Health EOS Commercial |
$4,102.90
|
| Rate for Payer: HFN Commercial |
$4,241.20
|
| Rate for Payer: Multiplan Commercial |
$3,688.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,766.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,241.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,258.90
|
| Rate for Payer: Quartz Commercial |
$2,766.00
|
| Rate for Payer: WEA Trust Commercial |
$2,535.50
|
| Rate for Payer: WPS Commercial |
$3,414.63
|
|
|
KIT RESUS ADJ MSK42 10 #RD1340-10
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2972716
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$1,172.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Aetna Managed Medicare |
$82.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.96
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$190.45
|
| Rate for Payer: Quartz Medicare Advantage |
$175.80
|
| Rate for Payer: The Alliance Commercial |
$1,172.00
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
