|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$95,955.60
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$28,886.52 |
| Max. Negotiated Rate |
$95,955.60 |
| Rate for Payer: Aetna Managed Medicare |
$28,886.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80,857.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61,976.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58,881.90
|
| Rate for Payer: Anthem Medicare Advantage |
$28,886.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,886.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,886.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,886.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65,364.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,886.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,136.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,886.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,886.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,886.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,886.52
|
| Rate for Payer: NAPHCARE Commercial |
$43,329.78
|
| Rate for Payer: Quartz Medicare Advantage |
$28,886.52
|
| Rate for Payer: The Alliance Commercial |
$95,955.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,886.52
|
| Rate for Payer: United Healthcare PPO |
$54,602.05
|
| Rate for Payer: Wellcare Medicare |
$28,886.52
|
|
|
KINESIO GOLD TEX TAPE - BLACK 081605120
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971981
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - BLACK 081605120
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971981
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - BLUE 081605278
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - BLUE 081605278
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - RED # A840241
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971983
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - RED # A840241
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971983
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIOTAPE BEIGE 5cm x31.5 BULK 0816-05-146
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
2969774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
KINESIOTAPE BEIGE 5cm x31.5 BULK 0816-05-146
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
2969774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$280.72 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$280.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.92
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| Rate for Payer: Quartz Medicare Advantage |
$601.54
|
| Rate for Payer: The Alliance Commercial |
$501.28
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
KIT 3.0 SUTURETAK DISP INSTR AR-8934DSC
|
Facility
|
OP
|
$1,802.00
|
|
| Hospital Charge Code |
6217008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$524.74 |
| Max. Negotiated Rate |
$1,724.15 |
| Rate for Payer: Aetna Commercial |
$1,686.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Aetna Managed Medicare |
$524.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$899.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.26
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,724.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,048.76
|
| Rate for Payer: Health EOS Commercial |
$1,667.93
|
| Rate for Payer: HFN Commercial |
$1,724.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,405.56
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,124.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,724.15
|
| Rate for Payer: Quartz Beloit One Network |
$918.30
|
| Rate for Payer: Quartz Commercial |
$1,218.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,124.45
|
| Rate for Payer: The Alliance Commercial |
$937.04
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: WPS Commercial |
$1,388.08
|
|
|
KIT 3.0 SUTURETAK DISP INSTR AR-8934DSC
|
Facility
|
IP
|
$1,802.00
|
|
| Hospital Charge Code |
6217008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$918.30 |
| Max. Negotiated Rate |
$1,724.15 |
| Rate for Payer: Aetna Commercial |
$1,686.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.26
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,724.15
|
| Rate for Payer: Health EOS Commercial |
$1,667.93
|
| Rate for Payer: HFN Commercial |
$1,724.15
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,724.15
|
| Rate for Payer: Quartz Beloit One Network |
$918.30
|
| Rate for Payer: Quartz Commercial |
$1,124.45
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: WPS Commercial |
$1,388.08
|
|
|
KIT 5MS DISP INSTRUMENT SINGLE USE P06 S0001
|
Facility
|
OP
|
$3,990.00
|
|
| Hospital Charge Code |
6172203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,161.89 |
| Max. Negotiated Rate |
$3,817.63 |
| Rate for Payer: Aetna Commercial |
$3,734.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,568.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,161.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,697.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,074.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,991.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,199.29
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$3,817.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,322.18
|
| Rate for Payer: Health EOS Commercial |
$3,693.14
|
| Rate for Payer: HFN Commercial |
$3,817.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,112.20
|
| Rate for Payer: Multiplan Commercial |
$3,319.68
|
| Rate for Payer: NAPHCARE Commercial |
$2,489.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,817.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,033.30
|
| Rate for Payer: Quartz Commercial |
$2,697.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,489.76
|
| Rate for Payer: The Alliance Commercial |
$2,074.80
|
| Rate for Payer: WEA Trust Commercial |
$2,282.28
|
| Rate for Payer: WPS Commercial |
$3,073.50
|
|
|
KIT 5MS DISP INSTRUMENT SINGLE USE P06 S0001
|
Facility
|
IP
|
$3,990.00
|
|
| Hospital Charge Code |
6172203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,033.30 |
| Max. Negotiated Rate |
$3,817.63 |
| Rate for Payer: Aetna Commercial |
$3,734.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,568.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,199.29
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna Commercial |
$3,817.63
|
| Rate for Payer: Health EOS Commercial |
$3,693.14
|
| Rate for Payer: HFN Commercial |
$3,817.63
|
| Rate for Payer: Multiplan Commercial |
$3,319.68
|
| Rate for Payer: Preferred Network Access Commercial |
$3,817.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,033.30
|
| Rate for Payer: Quartz Commercial |
$2,489.76
|
| Rate for Payer: WEA Trust Commercial |
$2,282.28
|
| Rate for Payer: WPS Commercial |
$3,073.50
|
|
|
KIT 7.5 40cc IAB
|
Facility
|
OP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,562.56 |
| Max. Negotiated Rate |
$8,419.84 |
| Rate for Payer: Aetna Commercial |
$8,236.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,870.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,562.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,948.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.56
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,419.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,121.60
|
| Rate for Payer: Health EOS Commercial |
$8,145.28
|
| Rate for Payer: HFN Commercial |
$8,419.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$7,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,491.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,419.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,484.48
|
| Rate for Payer: Quartz Commercial |
$5,948.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,491.20
|
| Rate for Payer: The Alliance Commercial |
$4,576.00
|
| Rate for Payer: WEA Trust Commercial |
$5,033.60
|
| Rate for Payer: WPS Commercial |
$6,778.64
|
|
|
KIT 7.5 40cc IAB
|
Facility
|
IP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,484.48 |
| Max. Negotiated Rate |
$8,419.84 |
| Rate for Payer: Aetna Commercial |
$8,236.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,870.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.56
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,419.84
|
| Rate for Payer: Health EOS Commercial |
$8,145.28
|
| Rate for Payer: HFN Commercial |
$8,419.84
|
| Rate for Payer: Multiplan Commercial |
$7,321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,419.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,484.48
|
| Rate for Payer: Quartz Commercial |
$5,491.20
|
| Rate for Payer: WEA Trust Commercial |
$5,033.60
|
| Rate for Payer: WPS Commercial |
$6,778.64
|
|
|
KIT ABLATION DISPOSIBLE ESTECH
|
Facility
|
IP
|
$15,253.00
|
|
| Hospital Charge Code |
2965112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,772.93 |
| Max. Negotiated Rate |
$14,594.07 |
| Rate for Payer: Aetna Commercial |
$14,276.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,642.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,407.45
|
| Rate for Payer: Cash Price |
$4,575.90
|
| Rate for Payer: Cigna Commercial |
$14,594.07
|
| Rate for Payer: Health EOS Commercial |
$14,118.18
|
| Rate for Payer: HFN Commercial |
$14,594.07
|
| Rate for Payer: Multiplan Commercial |
$12,690.50
|
| Rate for Payer: Preferred Network Access Commercial |
$14,594.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,772.93
|
| Rate for Payer: Quartz Commercial |
$9,517.87
|
| Rate for Payer: WEA Trust Commercial |
$8,724.72
|
| Rate for Payer: WPS Commercial |
$11,749.39
|
|
|
KIT ABLATION DISPOSIBLE ESTECH
|
Facility
|
OP
|
$15,253.00
|
|
| Hospital Charge Code |
2965112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,441.67 |
| Max. Negotiated Rate |
$14,594.07 |
| Rate for Payer: Aetna Commercial |
$14,276.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,642.28
|
| Rate for Payer: Aetna Managed Medicare |
$4,441.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,311.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,931.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,614.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,407.45
|
| Rate for Payer: Cash Price |
$4,575.90
|
| Rate for Payer: Cigna Commercial |
$14,594.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,877.25
|
| Rate for Payer: Health EOS Commercial |
$14,118.18
|
| Rate for Payer: HFN Commercial |
$14,594.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,897.34
|
| Rate for Payer: Multiplan Commercial |
$12,690.50
|
| Rate for Payer: NAPHCARE Commercial |
$9,517.87
|
| Rate for Payer: Preferred Network Access Commercial |
$14,594.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,772.93
|
| Rate for Payer: Quartz Commercial |
$10,311.03
|
| Rate for Payer: Quartz Medicare Advantage |
$9,517.87
|
| Rate for Payer: The Alliance Commercial |
$7,931.56
|
| Rate for Payer: WEA Trust Commercial |
$8,724.72
|
| Rate for Payer: WPS Commercial |
$11,749.39
|
|
|
KIT ACCELERATOR II FILTER/TUBING B5558-F
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
2965391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.48 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$298.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.55
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$799.50
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$639.60
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
KIT ACCELERATOR II FILTER/TUBING B5558-F
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
2965391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.34 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
KIT ACCESS PORT VG & APS
|
Facility
|
IP
|
$5,903.00
|
|
| Hospital Charge Code |
2964637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,008.17 |
| Max. Negotiated Rate |
$5,647.99 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,279.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,253.73
|
| Rate for Payer: Cash Price |
$1,770.90
|
| Rate for Payer: Cigna Commercial |
$5,647.99
|
| Rate for Payer: Health EOS Commercial |
$5,463.82
|
| Rate for Payer: HFN Commercial |
$5,647.99
|
| Rate for Payer: Multiplan Commercial |
$4,911.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,647.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,008.17
|
| Rate for Payer: Quartz Commercial |
$3,683.47
|
| Rate for Payer: WEA Trust Commercial |
$3,376.52
|
| Rate for Payer: WPS Commercial |
$4,547.08
|
|
|
KIT ACCESS PORT VG & APS
|
Facility
|
OP
|
$5,903.00
|
|
| Hospital Charge Code |
2964637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,718.95 |
| Max. Negotiated Rate |
$5,647.99 |
| Rate for Payer: Aetna Commercial |
$5,525.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,279.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,718.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,990.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,069.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,946.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,253.73
|
| Rate for Payer: Cash Price |
$1,770.90
|
| Rate for Payer: Cigna Commercial |
$5,647.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,435.55
|
| Rate for Payer: Health EOS Commercial |
$5,463.82
|
| Rate for Payer: HFN Commercial |
$5,647.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,604.34
|
| Rate for Payer: Multiplan Commercial |
$4,911.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,683.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,647.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,008.17
|
| Rate for Payer: Quartz Commercial |
$3,990.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,683.47
|
| Rate for Payer: The Alliance Commercial |
$3,069.56
|
| Rate for Payer: WEA Trust Commercial |
$3,376.52
|
| Rate for Payer: WPS Commercial |
$4,547.08
|
|
|
KIT ACL DISPOSABLE 232400
|
Facility
|
OP
|
$6,041.00
|
|
| Hospital Charge Code |
3072461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,759.14 |
| Max. Negotiated Rate |
$5,780.03 |
| Rate for Payer: Aetna Commercial |
$5,654.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,403.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,759.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,083.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,141.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,015.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,329.80
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,780.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,515.86
|
| Rate for Payer: Health EOS Commercial |
$5,591.55
|
| Rate for Payer: HFN Commercial |
$5,780.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,711.98
|
| Rate for Payer: Multiplan Commercial |
$5,026.11
|
| Rate for Payer: NAPHCARE Commercial |
$3,769.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,780.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,078.49
|
| Rate for Payer: Quartz Commercial |
$4,083.72
|
| Rate for Payer: Quartz Medicare Advantage |
$3,769.58
|
| Rate for Payer: The Alliance Commercial |
$3,141.32
|
| Rate for Payer: WEA Trust Commercial |
$3,455.45
|
| Rate for Payer: WPS Commercial |
$4,653.38
|
|
|
KIT ACL DISPOSABLE 232400
|
Facility
|
IP
|
$6,041.00
|
|
| Hospital Charge Code |
3072461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,078.49 |
| Max. Negotiated Rate |
$5,780.03 |
| Rate for Payer: Aetna Commercial |
$5,654.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,403.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,329.80
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,780.03
|
| Rate for Payer: Health EOS Commercial |
$5,591.55
|
| Rate for Payer: HFN Commercial |
$5,780.03
|
| Rate for Payer: Multiplan Commercial |
$5,026.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,780.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,078.49
|
| Rate for Payer: Quartz Commercial |
$3,769.58
|
| Rate for Payer: WEA Trust Commercial |
$3,455.45
|
| Rate for Payer: WPS Commercial |
$4,653.38
|
|
|
KIT ALLEN SHOULDER SUSPENSION A-21200-A7
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
2964624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$703.25 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$703.25
|
| Rate for Payer: Health EOS Commercial |
$680.32
|
| Rate for Payer: HFN Commercial |
$703.25
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: Preferred Network Access Commercial |
$703.25
|
| Rate for Payer: Quartz Beloit One Network |
$374.56
|
| Rate for Payer: Quartz Commercial |
$458.64
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$566.17
|
|
|
KIT ALLEN SHOULDER SUSPENSION A-21200-A7
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
2964624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$703.25 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Aetna Managed Medicare |
$214.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$496.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$382.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$366.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$703.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.77
|
| Rate for Payer: Health EOS Commercial |
$680.32
|
| Rate for Payer: HFN Commercial |
$703.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.30
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: NAPHCARE Commercial |
$458.64
|
| Rate for Payer: Preferred Network Access Commercial |
$703.25
|
| Rate for Payer: Quartz Beloit One Network |
$374.56
|
| Rate for Payer: Quartz Commercial |
$496.86
|
| Rate for Payer: Quartz Medicare Advantage |
$458.64
|
| Rate for Payer: The Alliance Commercial |
$382.20
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$566.17
|
|
