|
KIT GILL BIOPSY BRUSH G15045
|
Facility
|
OP
|
$1,269.00
|
|
| Hospital Charge Code |
2965865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.53 |
| Max. Negotiated Rate |
$1,214.18 |
| Rate for Payer: Aetna Commercial |
$1,187.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.99
|
| Rate for Payer: Aetna Managed Medicare |
$369.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$857.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$659.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.47
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,214.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.56
|
| Rate for Payer: Health EOS Commercial |
$1,174.59
|
| Rate for Payer: HFN Commercial |
$1,214.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$989.82
|
| Rate for Payer: Multiplan Commercial |
$1,055.81
|
| Rate for Payer: NAPHCARE Commercial |
$791.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.18
|
| Rate for Payer: Quartz Beloit One Network |
$646.68
|
| Rate for Payer: Quartz Commercial |
$857.84
|
| Rate for Payer: Quartz Medicare Advantage |
$791.86
|
| Rate for Payer: The Alliance Commercial |
$659.88
|
| Rate for Payer: WEA Trust Commercial |
$725.87
|
| Rate for Payer: WPS Commercial |
$977.51
|
|
|
KIT GOOSE NECK SNARE 25mm
|
Facility
|
OP
|
$3,539.00
|
|
| Hospital Charge Code |
2973398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,030.56 |
| Max. Negotiated Rate |
$3,386.12 |
| Rate for Payer: Aetna Commercial |
$3,312.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,030.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,392.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,840.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,766.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.70
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,386.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,059.70
|
| Rate for Payer: Health EOS Commercial |
$3,275.70
|
| Rate for Payer: HFN Commercial |
$3,386.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,760.42
|
| Rate for Payer: Multiplan Commercial |
$2,944.45
|
| Rate for Payer: NAPHCARE Commercial |
$2,208.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.47
|
| Rate for Payer: Quartz Commercial |
$2,392.36
|
| Rate for Payer: Quartz Medicare Advantage |
$2,208.34
|
| Rate for Payer: The Alliance Commercial |
$1,840.28
|
| Rate for Payer: WEA Trust Commercial |
$2,024.31
|
| Rate for Payer: WPS Commercial |
$2,726.09
|
|
|
KIT GOOSE NECK SNARE 25mm
|
Facility
|
IP
|
$3,539.00
|
|
| Hospital Charge Code |
2973398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,803.47 |
| Max. Negotiated Rate |
$3,386.12 |
| Rate for Payer: Aetna Commercial |
$3,312.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.70
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,386.12
|
| Rate for Payer: Health EOS Commercial |
$3,275.70
|
| Rate for Payer: HFN Commercial |
$3,386.12
|
| Rate for Payer: Multiplan Commercial |
$2,944.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.47
|
| Rate for Payer: Quartz Commercial |
$2,208.34
|
| Rate for Payer: WEA Trust Commercial |
$2,024.31
|
| Rate for Payer: WPS Commercial |
$2,726.09
|
|
|
KIT GROSHONG REPAIR DUAL 7740000
|
Facility
|
OP
|
$1,907.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.32 |
| Max. Negotiated Rate |
$1,824.62 |
| Rate for Payer: Aetna Commercial |
$1,784.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.62
|
| Rate for Payer: Aetna Managed Medicare |
$555.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,289.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.14
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,824.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.87
|
| Rate for Payer: Health EOS Commercial |
$1,765.12
|
| Rate for Payer: HFN Commercial |
$1,824.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.46
|
| Rate for Payer: Multiplan Commercial |
$1,586.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.62
|
| Rate for Payer: Quartz Beloit One Network |
$971.81
|
| Rate for Payer: Quartz Commercial |
$1,289.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.97
|
| Rate for Payer: The Alliance Commercial |
$991.64
|
| Rate for Payer: WEA Trust Commercial |
$1,090.80
|
| Rate for Payer: WPS Commercial |
$1,468.96
|
|
|
KIT GROSHONG REPAIR DUAL 7740000
|
Facility
|
IP
|
$1,907.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2962891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.81 |
| Max. Negotiated Rate |
$1,824.62 |
| Rate for Payer: Aetna Commercial |
$1,784.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.14
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,824.62
|
| Rate for Payer: Health EOS Commercial |
$1,765.12
|
| Rate for Payer: HFN Commercial |
$1,824.62
|
| Rate for Payer: Multiplan Commercial |
$1,586.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.62
|
| Rate for Payer: Quartz Beloit One Network |
$971.81
|
| Rate for Payer: Quartz Commercial |
$1,189.97
|
| Rate for Payer: WEA Trust Commercial |
$1,090.80
|
| Rate for Payer: WPS Commercial |
$1,468.96
|
|
|
KIT HIP ARTHROSCOPY MASTER DISPOSABLE WITH BLADE ARTHREX AR-6526S
|
Facility
|
OP
|
$5,130.00
|
|
| Hospital Charge Code |
5074892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,493.86 |
| Max. Negotiated Rate |
$4,908.38 |
| Rate for Payer: Aetna Commercial |
$4,801.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,588.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,493.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,467.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,667.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,560.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,827.66
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna Commercial |
$4,908.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,985.66
|
| Rate for Payer: Health EOS Commercial |
$4,748.33
|
| Rate for Payer: HFN Commercial |
$4,908.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,001.40
|
| Rate for Payer: Multiplan Commercial |
$4,268.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,201.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,908.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,614.25
|
| Rate for Payer: Quartz Commercial |
$3,467.88
|
| Rate for Payer: Quartz Medicare Advantage |
$3,201.12
|
| Rate for Payer: The Alliance Commercial |
$2,667.60
|
| Rate for Payer: WEA Trust Commercial |
$2,934.36
|
| Rate for Payer: WPS Commercial |
$3,951.64
|
|
|
KIT HIP ARTHROSCOPY MASTER DISPOSABLE WITH BLADE ARTHREX AR-6526S
|
Facility
|
IP
|
$5,130.00
|
|
| Hospital Charge Code |
5074892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,614.25 |
| Max. Negotiated Rate |
$4,908.38 |
| Rate for Payer: Aetna Commercial |
$4,801.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,588.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,827.66
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna Commercial |
$4,908.38
|
| Rate for Payer: Health EOS Commercial |
$4,748.33
|
| Rate for Payer: HFN Commercial |
$4,908.38
|
| Rate for Payer: Multiplan Commercial |
$4,268.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,908.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,614.25
|
| Rate for Payer: Quartz Commercial |
$3,201.12
|
| Rate for Payer: WEA Trust Commercial |
$2,934.36
|
| Rate for Payer: WPS Commercial |
$3,951.64
|
|
|
KIT HOOK / TRIANGLE BLADE 3056-6
|
Facility
|
IP
|
$2,087.00
|
|
| Hospital Charge Code |
5611596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,063.54 |
| Max. Negotiated Rate |
$1,996.84 |
| Rate for Payer: Aetna Commercial |
$1,953.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,866.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,150.35
|
| Rate for Payer: Cash Price |
$626.10
|
| Rate for Payer: Cigna Commercial |
$1,996.84
|
| Rate for Payer: Health EOS Commercial |
$1,931.73
|
| Rate for Payer: HFN Commercial |
$1,996.84
|
| Rate for Payer: Multiplan Commercial |
$1,736.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,996.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.54
|
| Rate for Payer: Quartz Commercial |
$1,302.29
|
| Rate for Payer: WEA Trust Commercial |
$1,193.76
|
| Rate for Payer: WPS Commercial |
$1,607.62
|
|
|
KIT HOOK / TRIANGLE BLADE 3056-6
|
Facility
|
OP
|
$2,087.00
|
|
| Hospital Charge Code |
5611596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.73 |
| Max. Negotiated Rate |
$1,996.84 |
| Rate for Payer: Aetna Commercial |
$1,953.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,866.61
|
| Rate for Payer: Aetna Managed Medicare |
$607.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,410.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,085.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,041.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,150.35
|
| Rate for Payer: Cash Price |
$626.10
|
| Rate for Payer: Cigna Commercial |
$1,996.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,214.63
|
| Rate for Payer: Health EOS Commercial |
$1,931.73
|
| Rate for Payer: HFN Commercial |
$1,996.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,627.86
|
| Rate for Payer: Multiplan Commercial |
$1,736.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,302.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,996.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.54
|
| Rate for Payer: Quartz Commercial |
$1,410.81
|
| Rate for Payer: Quartz Medicare Advantage |
$1,302.29
|
| Rate for Payer: The Alliance Commercial |
$1,085.24
|
| Rate for Payer: WEA Trust Commercial |
$1,193.76
|
| Rate for Payer: WPS Commercial |
$1,607.62
|
|
|
KIT HTR 10MM STERILE 220-10-003
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
4520500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
KIT HTR 10MM STERILE 220-10-003
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
4520500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.20 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,383.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,211.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,371.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,764.50
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,705.00
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$3,211.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,964.00
|
| Rate for Payer: The Alliance Commercial |
$2,470.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
KIT HTR 8MM STERILE 220-08-003
|
Facility
|
IP
|
$5,586.00
|
|
| Hospital Charge Code |
5107366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,846.63 |
| Max. Negotiated Rate |
$5,344.68 |
| Rate for Payer: Aetna Commercial |
$5,228.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,079.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,344.68
|
| Rate for Payer: Health EOS Commercial |
$5,170.40
|
| Rate for Payer: HFN Commercial |
$5,344.68
|
| Rate for Payer: Multiplan Commercial |
$4,647.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.63
|
| Rate for Payer: Quartz Commercial |
$3,485.66
|
| Rate for Payer: WEA Trust Commercial |
$3,195.19
|
| Rate for Payer: WPS Commercial |
$4,302.90
|
|
|
KIT HTR 8MM STERILE 220-08-003
|
Facility
|
OP
|
$5,586.00
|
|
| Hospital Charge Code |
5107366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,626.64 |
| Max. Negotiated Rate |
$5,344.68 |
| Rate for Payer: Aetna Commercial |
$5,228.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,626.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,776.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,904.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,788.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,079.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,344.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,251.05
|
| Rate for Payer: Health EOS Commercial |
$5,170.40
|
| Rate for Payer: HFN Commercial |
$5,344.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,357.08
|
| Rate for Payer: Multiplan Commercial |
$4,647.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,485.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.63
|
| Rate for Payer: Quartz Commercial |
$3,776.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,485.66
|
| Rate for Payer: The Alliance Commercial |
$2,904.72
|
| Rate for Payer: WEA Trust Commercial |
$3,195.19
|
| Rate for Payer: WPS Commercial |
$4,302.90
|
|
|
KIT INTERNAL JUGULAR PUNCTURE
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
2963414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$100.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.37
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.88
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$215.90
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$233.90
|
| Rate for Payer: Quartz Medicare Advantage |
$215.90
|
| Rate for Payer: The Alliance Commercial |
$179.92
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
KIT INTERNAL JUGULAR PUNCTURE
|
Facility
|
IP
|
$346.00
|
|
| Hospital Charge Code |
2963414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$215.90
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
KIT INTRODUCER JEJUNAL TUBE 10249
|
Facility
|
IP
|
$2,854.00
|
|
| Hospital Charge Code |
4520416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,454.40 |
| Max. Negotiated Rate |
$2,730.71 |
| Rate for Payer: Aetna Commercial |
$2,671.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,552.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.12
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$2,730.71
|
| Rate for Payer: Health EOS Commercial |
$2,641.66
|
| Rate for Payer: HFN Commercial |
$2,730.71
|
| Rate for Payer: Multiplan Commercial |
$2,374.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,730.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.40
|
| Rate for Payer: Quartz Commercial |
$1,780.90
|
| Rate for Payer: WEA Trust Commercial |
$1,632.49
|
| Rate for Payer: WPS Commercial |
$2,198.44
|
|
|
KIT INTRODUCER JEJUNAL TUBE 10249
|
Facility
|
OP
|
$2,854.00
|
|
| Hospital Charge Code |
4520416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.08 |
| Max. Negotiated Rate |
$2,730.71 |
| Rate for Payer: Aetna Commercial |
$2,671.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,552.62
|
| Rate for Payer: Aetna Managed Medicare |
$831.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,929.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,484.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,424.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.12
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$2,730.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,661.03
|
| Rate for Payer: Health EOS Commercial |
$2,641.66
|
| Rate for Payer: HFN Commercial |
$2,730.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,226.12
|
| Rate for Payer: Multiplan Commercial |
$2,374.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,780.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,730.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.40
|
| Rate for Payer: Quartz Commercial |
$1,929.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,780.90
|
| Rate for Payer: The Alliance Commercial |
$1,484.08
|
| Rate for Payer: WEA Trust Commercial |
$1,632.49
|
| Rate for Payer: WPS Commercial |
$2,198.44
|
|
|
KIT JEJUNAL MIC 22FR 45CM 7-10ML BALLOON 0250-22
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
4520415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
KIT JEJUNAL MIC 22FR 45CM 7-10ML BALLOON 0250-22
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
4520415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
KIT JOINT PREP KIT STERILE 9914PK01
|
Facility
|
OP
|
$2,572.00
|
|
| Hospital Charge Code |
6179802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.97 |
| Max. Negotiated Rate |
$2,460.89 |
| Rate for Payer: Aetna Commercial |
$2,407.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,300.40
|
| Rate for Payer: Aetna Managed Medicare |
$748.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.69
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,460.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.90
|
| Rate for Payer: Health EOS Commercial |
$2,380.64
|
| Rate for Payer: HFN Commercial |
$2,460.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,006.16
|
| Rate for Payer: Multiplan Commercial |
$2,139.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.69
|
| Rate for Payer: Quartz Commercial |
$1,738.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.93
|
| Rate for Payer: The Alliance Commercial |
$1,337.44
|
| Rate for Payer: WEA Trust Commercial |
$1,471.18
|
| Rate for Payer: WPS Commercial |
$1,981.21
|
|
|
KIT JOINT PREP KIT STERILE 9914PK01
|
Facility
|
IP
|
$2,572.00
|
|
| Hospital Charge Code |
6179802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.69 |
| Max. Negotiated Rate |
$2,460.89 |
| Rate for Payer: Aetna Commercial |
$2,407.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,300.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.69
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,460.89
|
| Rate for Payer: Health EOS Commercial |
$2,380.64
|
| Rate for Payer: HFN Commercial |
$2,460.89
|
| Rate for Payer: Multiplan Commercial |
$2,139.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.69
|
| Rate for Payer: Quartz Commercial |
$1,604.93
|
| Rate for Payer: WEA Trust Commercial |
$1,471.18
|
| Rate for Payer: WPS Commercial |
$1,981.21
|
|
|
KIT JOINT TIGHT ROPE AR-2257
|
Facility
|
OP
|
$5,884.00
|
|
| Hospital Charge Code |
2964715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,713.42 |
| Max. Negotiated Rate |
$5,629.81 |
| Rate for Payer: Aetna Commercial |
$5,507.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,262.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,713.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,977.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,059.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,937.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,243.26
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$5,629.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,424.49
|
| Rate for Payer: Health EOS Commercial |
$5,446.23
|
| Rate for Payer: HFN Commercial |
$5,629.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,589.52
|
| Rate for Payer: Multiplan Commercial |
$4,895.49
|
| Rate for Payer: NAPHCARE Commercial |
$3,671.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,629.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,998.49
|
| Rate for Payer: Quartz Commercial |
$3,977.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,671.62
|
| Rate for Payer: The Alliance Commercial |
$3,059.68
|
| Rate for Payer: WEA Trust Commercial |
$3,365.65
|
| Rate for Payer: WPS Commercial |
$4,532.45
|
|
|
KIT JOINT TIGHT ROPE AR-2257
|
Facility
|
IP
|
$5,884.00
|
|
| Hospital Charge Code |
2964715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,998.49 |
| Max. Negotiated Rate |
$5,629.81 |
| Rate for Payer: Aetna Commercial |
$5,507.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,262.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,243.26
|
| Rate for Payer: Cash Price |
$1,765.20
|
| Rate for Payer: Cigna Commercial |
$5,629.81
|
| Rate for Payer: Health EOS Commercial |
$5,446.23
|
| Rate for Payer: HFN Commercial |
$5,629.81
|
| Rate for Payer: Multiplan Commercial |
$4,895.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,629.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,998.49
|
| Rate for Payer: Quartz Commercial |
$3,671.62
|
| Rate for Payer: WEA Trust Commercial |
$3,365.65
|
| Rate for Payer: WPS Commercial |
$4,532.45
|
|
|
KIT JUGGERKNOT 2.9MM DISPOSIBLE 912057
|
Facility
|
IP
|
$4,156.00
|
|
| Hospital Charge Code |
4519986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,117.90 |
| Max. Negotiated Rate |
$3,976.46 |
| Rate for Payer: Aetna Commercial |
$3,890.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,717.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,290.79
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$3,976.46
|
| Rate for Payer: Health EOS Commercial |
$3,846.79
|
| Rate for Payer: HFN Commercial |
$3,976.46
|
| Rate for Payer: Multiplan Commercial |
$3,457.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,976.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,117.90
|
| Rate for Payer: Quartz Commercial |
$2,593.34
|
| Rate for Payer: WEA Trust Commercial |
$2,377.23
|
| Rate for Payer: WPS Commercial |
$3,201.37
|
|
|
KIT JUGGERKNOT 2.9MM DISPOSIBLE 912057
|
Facility
|
OP
|
$4,156.00
|
|
| Hospital Charge Code |
4519986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,210.23 |
| Max. Negotiated Rate |
$3,976.46 |
| Rate for Payer: Aetna Commercial |
$3,890.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,717.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,809.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,161.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,074.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,290.79
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$3,976.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,418.79
|
| Rate for Payer: Health EOS Commercial |
$3,846.79
|
| Rate for Payer: HFN Commercial |
$3,976.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,241.68
|
| Rate for Payer: Multiplan Commercial |
$3,457.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,593.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,976.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,117.90
|
| Rate for Payer: Quartz Commercial |
$2,809.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,593.34
|
| Rate for Payer: The Alliance Commercial |
$2,161.12
|
| Rate for Payer: WEA Trust Commercial |
$2,377.23
|
| Rate for Payer: WPS Commercial |
$3,201.37
|
|
