|
KIT CAVITY DRAINAGE CATH PERCUTANEOUS AK-01601
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.05 |
| Max. Negotiated Rate |
$1,603.60 |
| Rate for Payer: Aetna Commercial |
$1,568.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,499.01
|
| Rate for Payer: Aetna Managed Medicare |
$488.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,132.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$871.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$836.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.81
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$1,603.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$975.43
|
| Rate for Payer: Health EOS Commercial |
$1,551.31
|
| Rate for Payer: HFN Commercial |
$1,603.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,307.28
|
| Rate for Payer: Multiplan Commercial |
$1,394.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.09
|
| Rate for Payer: Quartz Commercial |
$1,132.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,045.82
|
| Rate for Payer: The Alliance Commercial |
$871.52
|
| Rate for Payer: WEA Trust Commercial |
$958.67
|
| Rate for Payer: WPS Commercial |
$1,291.02
|
|
|
KIT CAVITY DRAINAGE CATH PERCUTANEOUS AK-01601
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$854.09 |
| Max. Negotiated Rate |
$1,603.60 |
| Rate for Payer: Aetna Commercial |
$1,568.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,499.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.81
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$1,603.60
|
| Rate for Payer: Health EOS Commercial |
$1,551.31
|
| Rate for Payer: HFN Commercial |
$1,603.60
|
| Rate for Payer: Multiplan Commercial |
$1,394.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.09
|
| Rate for Payer: Quartz Commercial |
$1,045.82
|
| Rate for Payer: WEA Trust Commercial |
$958.67
|
| Rate for Payer: WPS Commercial |
$1,291.02
|
|
|
KIT CENTURION ULTRASOUND FLUID MANAGEMENT 8065752201
|
Facility
|
OP
|
$343.00
|
|
| Hospital Charge Code |
5107100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$328.18 |
| Rate for Payer: Aetna Commercial |
$321.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.78
|
| Rate for Payer: Aetna Managed Medicare |
$99.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.06
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$328.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.63
|
| Rate for Payer: Health EOS Commercial |
$317.48
|
| Rate for Payer: HFN Commercial |
$328.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.54
|
| Rate for Payer: Multiplan Commercial |
$285.38
|
| Rate for Payer: NAPHCARE Commercial |
$214.03
|
| Rate for Payer: Preferred Network Access Commercial |
$328.18
|
| Rate for Payer: Quartz Beloit One Network |
$174.79
|
| Rate for Payer: Quartz Commercial |
$231.87
|
| Rate for Payer: Quartz Medicare Advantage |
$214.03
|
| Rate for Payer: The Alliance Commercial |
$178.36
|
| Rate for Payer: WEA Trust Commercial |
$196.20
|
| Rate for Payer: WPS Commercial |
$264.21
|
|
|
KIT CENTURION ULTRASOUND FLUID MANAGEMENT 8065752201
|
Facility
|
IP
|
$343.00
|
|
| Hospital Charge Code |
5107100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.79 |
| Max. Negotiated Rate |
$328.18 |
| Rate for Payer: Aetna Commercial |
$321.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.06
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$328.18
|
| Rate for Payer: Health EOS Commercial |
$317.48
|
| Rate for Payer: HFN Commercial |
$328.18
|
| Rate for Payer: Multiplan Commercial |
$285.38
|
| Rate for Payer: Preferred Network Access Commercial |
$328.18
|
| Rate for Payer: Quartz Beloit One Network |
$174.79
|
| Rate for Payer: Quartz Commercial |
$214.03
|
| Rate for Payer: WEA Trust Commercial |
$196.20
|
| Rate for Payer: WPS Commercial |
$264.21
|
|
|
KIT CENTURION ULTRAVIT VITRECTOMY 8065752134
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
5107101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
KIT CENTURION ULTRAVIT VITRECTOMY 8065752134
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
5107101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$196.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$351.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.85
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.50
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$421.20
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
KIT CENT.VEN.CATH.FEM.ARTERY (MIN 5) EA C-PMS-301-FA***CUSTOM 6-8 WK LEAD TIME
|
Facility
|
OP
|
$543.00
|
|
| Hospital Charge Code |
2969242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$338.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$338.83
|
| Rate for Payer: The Alliance Commercial |
$282.36
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
KIT CENT.VEN.CATH.FEM.ARTERY (MIN 5) EA C-PMS-301-FA***CUSTOM 6-8 WK LEAD TIME
|
Facility
|
IP
|
$543.00
|
|
| Hospital Charge Code |
2969242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
KIT CIRCUIT CPAP / O2 #RT324
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
2973589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
KIT CIRCUIT CPAP / O2 #RT324
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
2973589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 100CM WITH MICRO INTRODUCER SET CPK55-11
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
4399654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,543.63 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,543.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,904.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,542.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,360.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,083.77
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,813.30
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,904.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5,450.64
|
| Rate for Payer: The Alliance Commercial |
$4,542.20
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 100CM WITH MICRO INTRODUCER SET CPK55-11
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
4399654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,451.36 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 3CM WITH MICRO INTRODUCER SET CPK83-11
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
4399655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,451.36 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 3CM WITH MICRO INTRODUCER SET CPK83-11
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
4399655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,543.63 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,543.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,904.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,542.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,360.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,083.77
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,813.30
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,904.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5,450.64
|
| Rate for Payer: The Alliance Commercial |
$4,542.20
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 11MMMICRO INTRODUCER SET CPK54-11
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
4399653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,451.36 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 11MMMICRO INTRODUCER SET CPK54-11
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
4399653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,543.63 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,543.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,904.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,542.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,360.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,083.77
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,813.30
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,904.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5,450.64
|
| Rate for Payer: The Alliance Commercial |
$4,542.20
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 7MMMICRO INTRODUCER SET CPK54-07
|
Facility
|
OP
|
$8,735.00
|
|
| Hospital Charge Code |
5286765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,543.63 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,543.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,904.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,542.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,360.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,083.77
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,813.30
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,904.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5,450.64
|
| Rate for Payer: The Alliance Commercial |
$4,542.20
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT CLOSUREFAST PACK AND CATHETER 60CM WITH 7MMMICRO INTRODUCER SET CPK54-07
|
Facility
|
IP
|
$8,735.00
|
|
| Hospital Charge Code |
5286765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,451.36 |
| Max. Negotiated Rate |
$8,357.65 |
| Rate for Payer: Aetna Commercial |
$8,175.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.73
|
| Rate for Payer: Cash Price |
$2,620.50
|
| Rate for Payer: Cigna Commercial |
$8,357.65
|
| Rate for Payer: Health EOS Commercial |
$8,085.12
|
| Rate for Payer: HFN Commercial |
$8,357.65
|
| Rate for Payer: Multiplan Commercial |
$7,267.52
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.36
|
| Rate for Payer: Quartz Commercial |
$5,450.64
|
| Rate for Payer: WEA Trust Commercial |
$4,996.42
|
| Rate for Payer: WPS Commercial |
$6,728.57
|
|
|
KIT COLAG 2 SCREW 3.0MM DISP INSTRUMENT SINGLE USE P06 S0003
|
Facility
|
OP
|
$3,990.00
|
|
| Hospital Charge Code |
6172082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,161.89 |
| Max. Negotiated Rate |
$3,817.63 |
| Rate for Payer: NAPHCARE Commercial |
$2,489.76
|
| 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: 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 COLAG 2 SCREW 3.0MM DISP INSTRUMENT SINGLE USE P06 S0003
|
Facility
|
IP
|
$3,990.00
|
|
| Hospital Charge Code |
6172082
|
|
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 COOLED RFA 17X100X4 CRKA-17-100-4
|
Facility
|
IP
|
$6,464.00
|
|
| Hospital Charge Code |
5414896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,294.05 |
| Max. Negotiated Rate |
$6,184.76 |
| Rate for Payer: Aetna Commercial |
$6,050.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,781.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.96
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cigna Commercial |
$6,184.76
|
| Rate for Payer: Health EOS Commercial |
$5,983.08
|
| Rate for Payer: HFN Commercial |
$6,184.76
|
| Rate for Payer: Multiplan Commercial |
$5,378.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,184.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,294.05
|
| Rate for Payer: Quartz Commercial |
$4,033.54
|
| Rate for Payer: WEA Trust Commercial |
$3,697.41
|
| Rate for Payer: WPS Commercial |
$4,979.22
|
|
|
KIT COOLED RFA 17X100X4 CRKA-17-100-4
|
Facility
|
OP
|
$6,464.00
|
|
| Hospital Charge Code |
5414896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,882.32 |
| Max. Negotiated Rate |
$6,184.76 |
| Rate for Payer: Aetna Commercial |
$6,050.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,781.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,882.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,369.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,361.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,226.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.96
|
| Rate for Payer: Cash Price |
$1,939.20
|
| Rate for Payer: Cigna Commercial |
$6,184.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,762.05
|
| Rate for Payer: Health EOS Commercial |
$5,983.08
|
| Rate for Payer: HFN Commercial |
$6,184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,041.92
|
| Rate for Payer: Multiplan Commercial |
$5,378.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,033.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,184.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,294.05
|
| Rate for Payer: Quartz Commercial |
$4,369.66
|
| Rate for Payer: Quartz Medicare Advantage |
$4,033.54
|
| Rate for Payer: The Alliance Commercial |
$3,361.28
|
| Rate for Payer: WEA Trust Commercial |
$3,697.41
|
| Rate for Payer: WPS Commercial |
$4,979.22
|
|
|
KIT COOLED RFA 17X100X4 MCKA2-17-100-4
|
Facility
|
IP
|
$8,616.00
|
|
| Hospital Charge Code |
5414897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,390.71 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,376.38
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
KIT COOLED RFA 17X100X4 MCKA2-17-100-4
|
Facility
|
OP
|
$8,616.00
|
|
| Hospital Charge Code |
5414897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,508.98 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,508.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,824.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,480.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,301.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,014.51
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,720.48
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,376.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,824.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,376.38
|
| Rate for Payer: The Alliance Commercial |
$4,480.32
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
KIT COOLED RFA 17 X 100 X 4 MCKA3-17-100-4
|
Facility
|
IP
|
$9,907.00
|
|
| Hospital Charge Code |
6049651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,048.61 |
| Max. Negotiated Rate |
$9,479.02 |
| Rate for Payer: Aetna Commercial |
$9,272.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,860.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,460.74
|
| Rate for Payer: Cash Price |
$2,972.10
|
| Rate for Payer: Cigna Commercial |
$9,479.02
|
| Rate for Payer: Health EOS Commercial |
$9,169.92
|
| Rate for Payer: HFN Commercial |
$9,479.02
|
| Rate for Payer: Multiplan Commercial |
$8,242.62
|
| Rate for Payer: Preferred Network Access Commercial |
$9,479.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,048.61
|
| Rate for Payer: Quartz Commercial |
$6,181.97
|
| Rate for Payer: WEA Trust Commercial |
$5,666.80
|
| Rate for Payer: WPS Commercial |
$7,631.36
|
|
