|
KIT COOLED RFA 17 X 100 X 4 MCKA3-17-100-4
|
Facility
|
OP
|
$9,907.00
|
|
| Hospital Charge Code |
6049651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,884.92 |
| 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: Aetna Managed Medicare |
$2,884.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,697.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,151.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,945.57
|
| 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: Dean Health DHI/DHP/ASO |
$5,765.87
|
| Rate for Payer: Health EOS Commercial |
$9,169.92
|
| Rate for Payer: HFN Commercial |
$9,479.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,727.46
|
| Rate for Payer: Multiplan Commercial |
$8,242.62
|
| Rate for Payer: NAPHCARE Commercial |
$6,181.97
|
| 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 |
$6,697.13
|
| Rate for Payer: Quartz Medicare Advantage |
$6,181.97
|
| Rate for Payer: The Alliance Commercial |
$5,151.64
|
| Rate for Payer: WEA Trust Commercial |
$5,666.80
|
| Rate for Payer: WPS Commercial |
$7,631.36
|
|
|
KIT COOLED RFA 17 X 150 X 4 MCKA3-17-150-4
|
Facility
|
OP
|
$10,623.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6001651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,093.42 |
| Max. Negotiated Rate |
$10,164.09 |
| Rate for Payer: Aetna Commercial |
$9,943.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,501.21
|
| Rate for Payer: Aetna Managed Medicare |
$3,093.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,181.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,523.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,303.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,855.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna Commercial |
$10,164.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,182.59
|
| Rate for Payer: Health EOS Commercial |
$9,832.65
|
| Rate for Payer: HFN Commercial |
$10,164.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,285.94
|
| Rate for Payer: Multiplan Commercial |
$8,838.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,628.75
|
| Rate for Payer: Preferred Network Access Commercial |
$10,164.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,413.48
|
| Rate for Payer: Quartz Commercial |
$7,181.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6,628.75
|
| Rate for Payer: The Alliance Commercial |
$5,523.96
|
| Rate for Payer: WEA Trust Commercial |
$6,076.36
|
| Rate for Payer: WPS Commercial |
$8,182.90
|
|
|
KIT COOLED RFA 17 X 150 X 4 MCKA3-17-150-4
|
Facility
|
IP
|
$10,623.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6001651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,413.48 |
| Max. Negotiated Rate |
$10,164.09 |
| Rate for Payer: Aetna Commercial |
$9,943.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,501.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,855.40
|
| Rate for Payer: Cash Price |
$3,186.90
|
| Rate for Payer: Cigna Commercial |
$10,164.09
|
| Rate for Payer: Health EOS Commercial |
$9,832.65
|
| Rate for Payer: HFN Commercial |
$10,164.09
|
| Rate for Payer: Multiplan Commercial |
$8,838.34
|
| Rate for Payer: Preferred Network Access Commercial |
$10,164.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,413.48
|
| Rate for Payer: Quartz Commercial |
$6,628.75
|
| Rate for Payer: WEA Trust Commercial |
$6,076.36
|
| Rate for Payer: WPS Commercial |
$8,182.90
|
|
|
KIT COOLED RFA 17X50X4 CRKA-17-50-4
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5264979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,049.45 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$3,734.02
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17X50X4 CRKA-17-50-4
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5264979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,742.54 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.69
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,667.52
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$4,045.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.02
|
| Rate for Payer: The Alliance Commercial |
$3,111.68
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17X75X4 CRKA-17-75-4
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5264978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,049.45 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$3,734.02
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17X75X4 CRKA-17-75-4
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5264978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,742.54 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.69
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,667.52
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$4,045.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.02
|
| Rate for Payer: The Alliance Commercial |
$3,111.68
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
KIT COOLED RFA 17 X 75 X 4 MCKA3-17-75-4
|
Facility
|
IP
|
$10,214.00
|
|
| Hospital Charge Code |
6049652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,205.05 |
| Max. Negotiated Rate |
$9,772.76 |
| Rate for Payer: Aetna Commercial |
$9,560.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,135.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,629.96
|
| Rate for Payer: Cash Price |
$3,064.20
|
| Rate for Payer: Cigna Commercial |
$9,772.76
|
| Rate for Payer: Health EOS Commercial |
$9,454.08
|
| Rate for Payer: HFN Commercial |
$9,772.76
|
| Rate for Payer: Multiplan Commercial |
$8,498.05
|
| Rate for Payer: Preferred Network Access Commercial |
$9,772.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,205.05
|
| Rate for Payer: Quartz Commercial |
$6,373.54
|
| Rate for Payer: WEA Trust Commercial |
$5,842.41
|
| Rate for Payer: WPS Commercial |
$7,867.84
|
|
|
KIT COOLED RFA 17 X 75 X 4 MCKA3-17-75-4
|
Facility
|
OP
|
$10,214.00
|
|
| Hospital Charge Code |
6049652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,974.32 |
| Max. Negotiated Rate |
$9,772.76 |
| Rate for Payer: Aetna Commercial |
$9,560.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,135.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,974.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,904.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,311.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,098.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,629.96
|
| Rate for Payer: Cash Price |
$3,064.20
|
| Rate for Payer: Cigna Commercial |
$9,772.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,944.55
|
| Rate for Payer: Health EOS Commercial |
$9,454.08
|
| Rate for Payer: HFN Commercial |
$9,772.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,966.92
|
| Rate for Payer: Multiplan Commercial |
$8,498.05
|
| Rate for Payer: NAPHCARE Commercial |
$6,373.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,772.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,205.05
|
| Rate for Payer: Quartz Commercial |
$6,904.66
|
| Rate for Payer: Quartz Medicare Advantage |
$6,373.54
|
| Rate for Payer: The Alliance Commercial |
$5,311.28
|
| Rate for Payer: WEA Trust Commercial |
$5,842.41
|
| Rate for Payer: WPS Commercial |
$7,867.84
|
|
|
KIT CROSSFIX PROCEDURE DISP
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
KIT CROSSFIX PROCEDURE DISP
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
KIT CTS RELIEF 9971
|
Facility
|
OP
|
$1,912.00
|
|
| Hospital Charge Code |
2964882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.77 |
| Max. Negotiated Rate |
$1,829.40 |
| Rate for Payer: Aetna Commercial |
$1,789.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,710.09
|
| Rate for Payer: Aetna Managed Medicare |
$556.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,292.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$994.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$954.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,053.89
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cigna Commercial |
$1,829.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,112.78
|
| Rate for Payer: Health EOS Commercial |
$1,769.75
|
| Rate for Payer: HFN Commercial |
$1,829.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,491.36
|
| Rate for Payer: Multiplan Commercial |
$1,590.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,193.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,829.40
|
| Rate for Payer: Quartz Beloit One Network |
$974.36
|
| Rate for Payer: Quartz Commercial |
$1,292.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,193.09
|
| Rate for Payer: The Alliance Commercial |
$994.24
|
| Rate for Payer: WEA Trust Commercial |
$1,093.66
|
| Rate for Payer: WPS Commercial |
$1,472.81
|
|
|
KIT CTS RELIEF 9971
|
Facility
|
IP
|
$1,912.00
|
|
| Hospital Charge Code |
2964882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$974.36 |
| Max. Negotiated Rate |
$1,829.40 |
| Rate for Payer: Aetna Commercial |
$1,789.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,710.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,053.89
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cigna Commercial |
$1,829.40
|
| Rate for Payer: Health EOS Commercial |
$1,769.75
|
| Rate for Payer: HFN Commercial |
$1,829.40
|
| Rate for Payer: Multiplan Commercial |
$1,590.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,829.40
|
| Rate for Payer: Quartz Beloit One Network |
$974.36
|
| Rate for Payer: Quartz Commercial |
$1,193.09
|
| Rate for Payer: WEA Trust Commercial |
$1,093.66
|
| Rate for Payer: WPS Commercial |
$1,472.81
|
|
|
KIT CUSTOM MANIFOLD (QTY OF 10) K09-10187
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
2972968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
KIT CUSTOM MANIFOLD (QTY OF 10) K09-10187
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
2972968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.74 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$107.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.34
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.60
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$230.88
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$250.12
|
| Rate for Payer: Quartz Medicare Advantage |
$230.88
|
| Rate for Payer: The Alliance Commercial |
$192.40
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
KIT CV MULTI LUMEN 7-8F SHEATH ARWAK21142SK
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
3065500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.44 |
| Max. Negotiated Rate |
$1,496.44 |
| Rate for Payer: Aetna Commercial |
$1,463.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,398.84
|
| Rate for Payer: Aetna Managed Medicare |
$455.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,057.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$813.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$780.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$862.08
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,496.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$910.25
|
| Rate for Payer: Health EOS Commercial |
$1,447.64
|
| Rate for Payer: HFN Commercial |
$1,496.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,219.92
|
| Rate for Payer: Multiplan Commercial |
$1,301.25
|
| Rate for Payer: NAPHCARE Commercial |
$975.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,496.44
|
| Rate for Payer: Quartz Beloit One Network |
$797.01
|
| Rate for Payer: Quartz Commercial |
$1,057.26
|
| Rate for Payer: Quartz Medicare Advantage |
$975.94
|
| Rate for Payer: The Alliance Commercial |
$813.28
|
| Rate for Payer: WEA Trust Commercial |
$894.61
|
| Rate for Payer: WPS Commercial |
$1,204.75
|
|
|
KIT CV MULTI LUMEN 7-8F SHEATH ARWAK21142SK
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
3065500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$797.01 |
| Max. Negotiated Rate |
$1,496.44 |
| Rate for Payer: Aetna Commercial |
$1,463.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,398.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$862.08
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,496.44
|
| Rate for Payer: Health EOS Commercial |
$1,447.64
|
| Rate for Payer: HFN Commercial |
$1,496.44
|
| Rate for Payer: Multiplan Commercial |
$1,301.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,496.44
|
| Rate for Payer: Quartz Beloit One Network |
$797.01
|
| Rate for Payer: Quartz Commercial |
$975.94
|
| Rate for Payer: WEA Trust Commercial |
$894.61
|
| Rate for Payer: WPS Commercial |
$1,204.75
|
|
|
KIT DEMAYO KNEE POSITIONER 803-GP-10
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2965163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
KIT DEMAYO KNEE POSITIONER 803-GP-10
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2965163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
KIT DISP DX KNOTLESS FIBERTAK AR-8991DS
|
Facility
|
IP
|
$2,601.00
|
|
| Hospital Charge Code |
6181680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.47 |
| Max. Negotiated Rate |
$2,488.64 |
| Rate for Payer: Aetna Commercial |
$2,434.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,326.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.67
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cigna Commercial |
$2,488.64
|
| Rate for Payer: Health EOS Commercial |
$2,407.49
|
| Rate for Payer: HFN Commercial |
$2,488.64
|
| Rate for Payer: Multiplan Commercial |
$2,164.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.47
|
| Rate for Payer: Quartz Commercial |
$1,623.02
|
| Rate for Payer: WEA Trust Commercial |
$1,487.77
|
| Rate for Payer: WPS Commercial |
$2,003.55
|
|
|
KIT DISP DX KNOTLESS FIBERTAK AR-8991DS
|
Facility
|
OP
|
$2,601.00
|
|
| Hospital Charge Code |
6181680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.41 |
| Max. Negotiated Rate |
$2,488.64 |
| Rate for Payer: Aetna Commercial |
$2,434.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,326.33
|
| Rate for Payer: Aetna Managed Medicare |
$757.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,758.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,352.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,298.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.67
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cigna Commercial |
$2,488.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,513.78
|
| Rate for Payer: Health EOS Commercial |
$2,407.49
|
| Rate for Payer: HFN Commercial |
$2,488.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.78
|
| Rate for Payer: Multiplan Commercial |
$2,164.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.47
|
| Rate for Payer: Quartz Commercial |
$1,758.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,623.02
|
| Rate for Payer: The Alliance Commercial |
$1,352.52
|
| Rate for Payer: WEA Trust Commercial |
$1,487.77
|
| Rate for Payer: WPS Commercial |
$2,003.55
|
|
|
KIT DISP INSTR 3.9MM KNOTLESS CORKSCREW AR-1941DS
|
Facility
|
OP
|
$4,490.00
|
|
| Hospital Charge Code |
5547341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,307.49 |
| Max. Negotiated Rate |
$4,296.03 |
| Rate for Payer: Aetna Commercial |
$4,202.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,015.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,307.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,035.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,334.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,241.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,474.89
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$4,296.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,613.18
|
| Rate for Payer: Health EOS Commercial |
$4,155.94
|
| Rate for Payer: HFN Commercial |
$4,296.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,502.20
|
| Rate for Payer: Multiplan Commercial |
$3,735.68
|
| Rate for Payer: NAPHCARE Commercial |
$2,801.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,296.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,288.10
|
| Rate for Payer: Quartz Commercial |
$3,035.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,801.76
|
| Rate for Payer: The Alliance Commercial |
$2,334.80
|
| Rate for Payer: WEA Trust Commercial |
$2,568.28
|
| Rate for Payer: WPS Commercial |
$3,458.65
|
|
|
KIT DISP INSTR 3.9MM KNOTLESS CORKSCREW AR-1941DS
|
Facility
|
IP
|
$4,490.00
|
|
| Hospital Charge Code |
5547341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,288.10 |
| Max. Negotiated Rate |
$4,296.03 |
| Rate for Payer: Aetna Commercial |
$4,202.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,015.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,474.89
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$4,296.03
|
| Rate for Payer: Health EOS Commercial |
$4,155.94
|
| Rate for Payer: HFN Commercial |
$4,296.03
|
| Rate for Payer: Multiplan Commercial |
$3,735.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,296.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,288.10
|
| Rate for Payer: Quartz Commercial |
$2,801.76
|
| Rate for Payer: WEA Trust Commercial |
$2,568.28
|
| Rate for Payer: WPS Commercial |
$3,458.65
|
|
|
KIT DISP SWIVELOCK 3.5 X 8.5MM AR-8978DS
|
Facility
|
IP
|
$4,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.15 |
| Max. Negotiated Rate |
$4,001.34 |
| Rate for Payer: Aetna Commercial |
$3,914.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,740.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,305.12
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$4,001.34
|
| Rate for Payer: Health EOS Commercial |
$3,870.86
|
| Rate for Payer: HFN Commercial |
$4,001.34
|
| Rate for Payer: Multiplan Commercial |
$3,479.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,001.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,131.15
|
| Rate for Payer: Quartz Commercial |
$2,609.57
|
| Rate for Payer: WEA Trust Commercial |
$2,392.10
|
| Rate for Payer: WPS Commercial |
$3,221.39
|
|
|
KIT DISP SWIVELOCK 3.5 X 8.5MM AR-8978DS
|
Facility
|
OP
|
$4,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.80 |
| Max. Negotiated Rate |
$4,001.34 |
| Rate for Payer: Aetna Commercial |
$3,914.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,740.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,217.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,827.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,305.12
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$4,001.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.92
|
| Rate for Payer: Health EOS Commercial |
$3,870.86
|
| Rate for Payer: HFN Commercial |
$4,001.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,261.96
|
| Rate for Payer: Multiplan Commercial |
$3,479.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,609.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,001.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,131.15
|
| Rate for Payer: Quartz Commercial |
$2,827.03
|
| Rate for Payer: Quartz Medicare Advantage |
$2,609.57
|
| Rate for Payer: The Alliance Commercial |
$2,174.64
|
| Rate for Payer: WEA Trust Commercial |
$2,392.10
|
| Rate for Payer: WPS Commercial |
$3,221.39
|
|
