|
KIT TENODESIS GRAFT SIZING W FIBERLOOK SUTURETAPE & NEEDLE AR-1676ST
|
Facility
|
OP
|
$2,790.00
|
|
| Hospital Charge Code |
6185036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
KIT TENODESIS GRAFT SIZING W FIBERLOOK SUTURETAPE & NEEDLE AR-1676ST
|
Facility
|
IP
|
$2,790.00
|
|
| Hospital Charge Code |
6185036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
KIT THD SLIDE ONE STERILE PROCEDURE 800070
|
Facility
|
OP
|
$4,968.00
|
|
| Hospital Charge Code |
4226511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,391.04 |
| Max. Negotiated Rate |
$19,872.00 |
| Rate for Payer: Aetna Commercial |
$4,471.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,272.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,391.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,229.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,384.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,633.04
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,570.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,780.09
|
| Rate for Payer: Health EOS Commercial |
$4,421.52
|
| Rate for Payer: HFN Commercial |
$4,570.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,726.00
|
| Rate for Payer: Multiplan Commercial |
$3,974.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,980.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,570.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.32
|
| Rate for Payer: Quartz Commercial |
$3,229.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,980.80
|
| Rate for Payer: The Alliance Commercial |
$19,872.00
|
| Rate for Payer: WEA Trust Commercial |
$2,732.40
|
| Rate for Payer: WPS Commercial |
$3,679.80
|
|
|
KIT THD SLIDE ONE STERILE PROCEDURE 800070
|
Facility
|
IP
|
$4,968.00
|
|
| Hospital Charge Code |
4226511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,434.32 |
| Max. Negotiated Rate |
$4,570.56 |
| Rate for Payer: Aetna Commercial |
$4,471.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,272.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,633.04
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,570.56
|
| Rate for Payer: Health EOS Commercial |
$4,421.52
|
| Rate for Payer: HFN Commercial |
$4,570.56
|
| Rate for Payer: Multiplan Commercial |
$3,974.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,980.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,570.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.32
|
| Rate for Payer: Quartz Commercial |
$2,980.80
|
| Rate for Payer: WEA Trust Commercial |
$2,732.40
|
| Rate for Payer: WPS Commercial |
$3,679.80
|
|
|
KIT THORACENTESIS
|
Facility
|
OP
|
$739.00
|
|
| Hospital Charge Code |
2963544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
KIT THORACENTESIS
|
Facility
|
IP
|
$739.00
|
|
| Hospital Charge Code |
2963544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
KIT TRANSDUCER DOUBLE LINE MONITORING 42652-05
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
2963102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
KIT TRANSDUCER DOUBLE LINE MONITORING 42652-05
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
2963102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
KIT TRANSDUCER SINGLE LINE 42584-05
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2963067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
KIT TRANSDUCER SINGLE LINE 42584-05
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2963067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$175.20
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
KIT TRANSTIBIAL ACL DISPOSABLE AR-1898S
|
Facility
|
OP
|
$3,611.00
|
|
| Hospital Charge Code |
2964687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,011.08 |
| Max. Negotiated Rate |
$14,444.00 |
| Rate for Payer: Aetna Commercial |
$3,249.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,105.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,011.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,347.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,805.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,733.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,913.83
|
| Rate for Payer: Cash Price |
$1,083.30
|
| Rate for Payer: Cigna Commercial |
$3,322.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,020.72
|
| Rate for Payer: Health EOS Commercial |
$3,213.79
|
| Rate for Payer: HFN Commercial |
$3,322.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,708.25
|
| Rate for Payer: Multiplan Commercial |
$2,888.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,166.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,322.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,769.39
|
| Rate for Payer: Quartz Commercial |
$2,347.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,166.60
|
| Rate for Payer: The Alliance Commercial |
$14,444.00
|
| Rate for Payer: WEA Trust Commercial |
$1,986.05
|
| Rate for Payer: WPS Commercial |
$2,674.67
|
|
|
KIT TRANSTIBIAL ACL DISPOSABLE AR-1898S
|
Facility
|
IP
|
$3,611.00
|
|
| Hospital Charge Code |
2964687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,769.39 |
| Max. Negotiated Rate |
$3,322.12 |
| Rate for Payer: Aetna Commercial |
$3,249.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,105.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,913.83
|
| Rate for Payer: Cash Price |
$1,083.30
|
| Rate for Payer: Cigna Commercial |
$3,322.12
|
| Rate for Payer: Health EOS Commercial |
$3,213.79
|
| Rate for Payer: HFN Commercial |
$3,322.12
|
| Rate for Payer: Multiplan Commercial |
$2,888.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,166.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,322.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,769.39
|
| Rate for Payer: Quartz Commercial |
$2,166.60
|
| Rate for Payer: WEA Trust Commercial |
$1,986.05
|
| Rate for Payer: WPS Commercial |
$2,674.67
|
|
|
KIT TRAUMA AK-05801
|
Facility
|
IP
|
$596.00
|
|
| Hospital Charge Code |
2962981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
KIT TRAUMA AK-05801
|
Facility
|
OP
|
$596.00
|
|
| Hospital Charge Code |
2962981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.52
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
KIT TRIMANO ARM POSITIONER
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
KIT TRIMANO ARM POSITIONER
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
KIT UCL SUTURE PASSING DISP AR-7715-4.5
|
Facility
|
IP
|
$7,618.00
|
|
| Hospital Charge Code |
5923707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,732.82 |
| Max. Negotiated Rate |
$7,008.56 |
| Rate for Payer: Aetna Commercial |
$6,856.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,551.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,037.54
|
| Rate for Payer: Cash Price |
$2,285.40
|
| Rate for Payer: Cigna Commercial |
$7,008.56
|
| Rate for Payer: Health EOS Commercial |
$6,780.02
|
| Rate for Payer: HFN Commercial |
$7,008.56
|
| Rate for Payer: Multiplan Commercial |
$6,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,570.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,008.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,732.82
|
| Rate for Payer: Quartz Commercial |
$4,570.80
|
| Rate for Payer: WEA Trust Commercial |
$4,189.90
|
| Rate for Payer: WPS Commercial |
$5,642.65
|
|
|
KIT UCL SUTURE PASSING DISP AR-7715-4.5
|
Facility
|
OP
|
$7,618.00
|
|
| Hospital Charge Code |
5923707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,133.04 |
| Max. Negotiated Rate |
$30,472.00 |
| Rate for Payer: Aetna Commercial |
$6,856.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,551.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,133.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,951.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,809.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,656.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,037.54
|
| Rate for Payer: Cash Price |
$2,285.40
|
| Rate for Payer: Cigna Commercial |
$7,008.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,263.03
|
| Rate for Payer: Health EOS Commercial |
$6,780.02
|
| Rate for Payer: HFN Commercial |
$7,008.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,713.50
|
| Rate for Payer: Multiplan Commercial |
$6,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,570.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,008.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,732.82
|
| Rate for Payer: Quartz Commercial |
$4,951.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,570.80
|
| Rate for Payer: The Alliance Commercial |
$30,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,189.90
|
| Rate for Payer: WPS Commercial |
$5,642.65
|
|
|
KIT UROMAX DILATION 30FR X 4CM M0062251050
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4595300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.24 |
| Max. Negotiated Rate |
$10,632.00 |
| Rate for Payer: Aetna Commercial |
$2,392.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,285.88
|
| Rate for Payer: Aetna Managed Medicare |
$744.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,727.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,275.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,408.74
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cigna Commercial |
$2,445.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,487.42
|
| Rate for Payer: Health EOS Commercial |
$2,365.62
|
| Rate for Payer: HFN Commercial |
$2,445.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,993.50
|
| Rate for Payer: Multiplan Commercial |
$2,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,594.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.42
|
| Rate for Payer: Quartz Commercial |
$1,727.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,594.80
|
| Rate for Payer: The Alliance Commercial |
$10,632.00
|
| Rate for Payer: WEA Trust Commercial |
$1,461.90
|
| Rate for Payer: WPS Commercial |
$1,968.78
|
|
|
KIT UROMAX DILATION 30FR X 4CM M0062251050
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4595300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,302.42 |
| Max. Negotiated Rate |
$2,445.36 |
| Rate for Payer: Aetna Commercial |
$2,392.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,285.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,408.74
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cigna Commercial |
$2,445.36
|
| Rate for Payer: Health EOS Commercial |
$2,365.62
|
| Rate for Payer: HFN Commercial |
$2,445.36
|
| Rate for Payer: Multiplan Commercial |
$2,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,594.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.42
|
| Rate for Payer: Quartz Commercial |
$1,594.80
|
| Rate for Payer: WEA Trust Commercial |
$1,461.90
|
| Rate for Payer: WPS Commercial |
$1,968.78
|
|
|
KIT UROMAX DILATION 4MM X 4CM M0062251200
|
Facility
|
IP
|
$2,956.00
|
|
| Hospital Charge Code |
4520084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,448.44 |
| Max. Negotiated Rate |
$2,719.52 |
| Rate for Payer: Aetna Commercial |
$2,660.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,542.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.68
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cigna Commercial |
$2,719.52
|
| Rate for Payer: Health EOS Commercial |
$2,630.84
|
| Rate for Payer: HFN Commercial |
$2,719.52
|
| Rate for Payer: Multiplan Commercial |
$2,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,719.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,448.44
|
| Rate for Payer: Quartz Commercial |
$1,773.60
|
| Rate for Payer: WEA Trust Commercial |
$1,625.80
|
| Rate for Payer: WPS Commercial |
$2,189.51
|
|
|
KIT UROMAX DILATION 4MM X 4CM M0062251200
|
Facility
|
OP
|
$2,956.00
|
|
| Hospital Charge Code |
4520084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.68 |
| Max. Negotiated Rate |
$11,824.00 |
| Rate for Payer: Aetna Commercial |
$2,660.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,542.16
|
| Rate for Payer: Aetna Managed Medicare |
$827.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,921.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,478.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,418.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.68
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cigna Commercial |
$2,719.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,654.18
|
| Rate for Payer: Health EOS Commercial |
$2,630.84
|
| Rate for Payer: HFN Commercial |
$2,719.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,217.00
|
| Rate for Payer: Multiplan Commercial |
$2,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,719.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,448.44
|
| Rate for Payer: Quartz Commercial |
$1,921.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,773.60
|
| Rate for Payer: The Alliance Commercial |
$11,824.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.80
|
| Rate for Payer: WPS Commercial |
$2,189.51
|
|
|
KIT UROMAX DILATION 6MM X 4CM M0062251020
|
Facility
|
IP
|
$2,844.00
|
|
| Hospital Charge Code |
4520085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,393.56 |
| Max. Negotiated Rate |
$2,616.48 |
| Rate for Payer: Aetna Commercial |
$2,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,507.32
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,616.48
|
| Rate for Payer: Health EOS Commercial |
$2,531.16
|
| Rate for Payer: HFN Commercial |
$2,616.48
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,616.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.56
|
| Rate for Payer: Quartz Commercial |
$1,706.40
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
KIT UROMAX DILATION 6MM X 4CM M0062251020
|
Facility
|
OP
|
$2,844.00
|
|
| Hospital Charge Code |
4520085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$796.32 |
| Max. Negotiated Rate |
$11,376.00 |
| Rate for Payer: Aetna Commercial |
$2,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Aetna Managed Medicare |
$796.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,848.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,422.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,365.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,507.32
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,616.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,591.50
|
| Rate for Payer: Health EOS Commercial |
$2,531.16
|
| Rate for Payer: HFN Commercial |
$2,616.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,133.00
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,616.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.56
|
| Rate for Payer: Quartz Commercial |
$1,848.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,706.40
|
| Rate for Payer: The Alliance Commercial |
$11,376.00
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
KIT VTC NEPHROSTOMY 10fr M001271870
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2973047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,067.22 |
| Max. Negotiated Rate |
$2,003.76 |
| Rate for Payer: Aetna Commercial |
$1,960.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.34
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna Commercial |
$2,003.76
|
| Rate for Payer: Health EOS Commercial |
$1,938.42
|
| Rate for Payer: HFN Commercial |
$2,003.76
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,306.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,003.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.22
|
| Rate for Payer: Quartz Commercial |
$1,306.80
|
| Rate for Payer: WEA Trust Commercial |
$1,197.90
|
| Rate for Payer: WPS Commercial |
$1,613.24
|
|
