|
KIT JUJUNOSTOMY
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
2973679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.23 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
KIT JUJUNOSTOMY
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
2973679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
KIT LEAD INTERSTIM II SURESCAN MRI 4.32MM X 28CM (RECHARGE FREE) 978B128
|
Facility
|
OP
|
$24,223.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5603547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,053.74 |
| Max. Negotiated Rate |
$23,176.57 |
| Rate for Payer: Aetna Commercial |
$22,672.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,665.05
|
| Rate for Payer: Aetna Managed Medicare |
$7,053.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,595.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,092.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,351.72
|
| Rate for Payer: Cash Price |
$7,266.90
|
| Rate for Payer: Cigna Commercial |
$23,176.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,097.79
|
| Rate for Payer: Health EOS Commercial |
$22,420.81
|
| Rate for Payer: HFN Commercial |
$23,176.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,893.94
|
| Rate for Payer: Multiplan Commercial |
$20,153.54
|
| Rate for Payer: NAPHCARE Commercial |
$15,115.15
|
| Rate for Payer: Preferred Network Access Commercial |
$23,176.57
|
| Rate for Payer: Quartz Beloit One Network |
$12,344.04
|
| Rate for Payer: Quartz Commercial |
$16,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$15,115.15
|
| Rate for Payer: The Alliance Commercial |
$12,595.96
|
| Rate for Payer: WEA Trust Commercial |
$13,855.56
|
| Rate for Payer: WPS Commercial |
$18,658.98
|
|
|
KIT LEAD INTERSTIM II SURESCAN MRI 4.32MM X 28CM (RECHARGE FREE) 978B128
|
Facility
|
IP
|
$24,223.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5603547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,344.04 |
| Max. Negotiated Rate |
$23,176.57 |
| Rate for Payer: Aetna Commercial |
$22,672.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,665.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,351.72
|
| Rate for Payer: Cash Price |
$7,266.90
|
| Rate for Payer: Cigna Commercial |
$23,176.57
|
| Rate for Payer: Health EOS Commercial |
$22,420.81
|
| Rate for Payer: HFN Commercial |
$23,176.57
|
| Rate for Payer: Multiplan Commercial |
$20,153.54
|
| Rate for Payer: Preferred Network Access Commercial |
$23,176.57
|
| Rate for Payer: Quartz Beloit One Network |
$12,344.04
|
| Rate for Payer: Quartz Commercial |
$15,115.15
|
| Rate for Payer: WEA Trust Commercial |
$13,855.56
|
| Rate for Payer: WPS Commercial |
$18,658.98
|
|
|
KIT LEAD INTRODUCER INTERSTIM 3550-18
|
Facility
|
OP
|
$3,411.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5349491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.28 |
| Max. Negotiated Rate |
$3,263.64 |
| Rate for Payer: Aetna Commercial |
$3,192.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,050.80
|
| Rate for Payer: Aetna Managed Medicare |
$993.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,305.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,773.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,702.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,880.14
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cigna Commercial |
$3,263.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,985.20
|
| Rate for Payer: Health EOS Commercial |
$3,157.22
|
| Rate for Payer: HFN Commercial |
$3,263.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,660.58
|
| Rate for Payer: Multiplan Commercial |
$2,837.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,128.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,738.25
|
| Rate for Payer: Quartz Commercial |
$2,305.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,128.46
|
| Rate for Payer: The Alliance Commercial |
$1,773.72
|
| Rate for Payer: WEA Trust Commercial |
$1,951.09
|
| Rate for Payer: WPS Commercial |
$2,627.49
|
|
|
KIT LEAD INTRODUCER INTERSTIM 3550-18
|
Facility
|
IP
|
$3,411.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5349491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,738.25 |
| Max. Negotiated Rate |
$3,263.64 |
| Rate for Payer: Aetna Commercial |
$3,192.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,050.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,880.14
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cigna Commercial |
$3,263.64
|
| Rate for Payer: Health EOS Commercial |
$3,157.22
|
| Rate for Payer: HFN Commercial |
$3,263.64
|
| Rate for Payer: Multiplan Commercial |
$2,837.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,738.25
|
| Rate for Payer: Quartz Commercial |
$2,128.46
|
| Rate for Payer: WEA Trust Commercial |
$1,951.09
|
| Rate for Payer: WPS Commercial |
$2,627.49
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.4MM X 445MM & STONE CATCHER M0068403530
|
Facility
|
IP
|
$6,102.00
|
|
| Hospital Charge Code |
5804330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,109.58 |
| Max. Negotiated Rate |
$5,838.39 |
| Rate for Payer: Aetna Commercial |
$5,711.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,457.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,363.42
|
| Rate for Payer: Cash Price |
$1,830.60
|
| Rate for Payer: Cigna Commercial |
$5,838.39
|
| Rate for Payer: Health EOS Commercial |
$5,648.01
|
| Rate for Payer: HFN Commercial |
$5,838.39
|
| Rate for Payer: Multiplan Commercial |
$5,076.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,838.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,109.58
|
| Rate for Payer: Quartz Commercial |
$3,807.65
|
| Rate for Payer: WEA Trust Commercial |
$3,490.34
|
| Rate for Payer: WPS Commercial |
$4,700.37
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.4MM X 445MM & STONE CATCHER M0068403530
|
Facility
|
OP
|
$6,102.00
|
|
| Hospital Charge Code |
5804330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,776.90 |
| Max. Negotiated Rate |
$5,838.39 |
| Rate for Payer: Aetna Commercial |
$5,711.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,457.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,124.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,173.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,046.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,363.42
|
| Rate for Payer: Cash Price |
$1,830.60
|
| Rate for Payer: Cigna Commercial |
$5,838.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,551.36
|
| Rate for Payer: Health EOS Commercial |
$5,648.01
|
| Rate for Payer: HFN Commercial |
$5,838.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,759.56
|
| Rate for Payer: Multiplan Commercial |
$5,076.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,807.65
|
| Rate for Payer: Preferred Network Access Commercial |
$5,838.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,109.58
|
| Rate for Payer: Quartz Commercial |
$4,124.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,807.65
|
| Rate for Payer: The Alliance Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$3,490.34
|
| Rate for Payer: WPS Commercial |
$4,700.37
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.9MM X 440MM & STONE CATCHER M0068403550/M0068402980/M0068402940
|
Facility
|
IP
|
$7,899.00
|
|
| Hospital Charge Code |
5459256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,025.33 |
| Max. Negotiated Rate |
$7,557.76 |
| Rate for Payer: Aetna Commercial |
$7,393.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.93
|
| Rate for Payer: Cash Price |
$2,369.70
|
| Rate for Payer: Cigna Commercial |
$7,557.76
|
| Rate for Payer: Health EOS Commercial |
$7,311.31
|
| Rate for Payer: HFN Commercial |
$7,557.76
|
| Rate for Payer: Multiplan Commercial |
$6,571.97
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.33
|
| Rate for Payer: Quartz Commercial |
$4,928.98
|
| Rate for Payer: WEA Trust Commercial |
$4,518.23
|
| Rate for Payer: WPS Commercial |
$6,084.60
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.9MM X 440MM & STONE CATCHER M0068403550/M0068402980/M0068402940
|
Facility
|
OP
|
$7,899.00
|
|
| Hospital Charge Code |
5459256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,300.19 |
| Max. Negotiated Rate |
$7,557.76 |
| Rate for Payer: Aetna Commercial |
$7,393.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.93
|
| Rate for Payer: Cash Price |
$2,369.70
|
| Rate for Payer: Cigna Commercial |
$7,557.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.22
|
| Rate for Payer: Health EOS Commercial |
$7,311.31
|
| Rate for Payer: HFN Commercial |
$7,557.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.22
|
| Rate for Payer: Multiplan Commercial |
$6,571.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,928.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.33
|
| Rate for Payer: Quartz Commercial |
$5,339.72
|
| Rate for Payer: Quartz Medicare Advantage |
$4,928.98
|
| Rate for Payer: The Alliance Commercial |
$4,107.48
|
| Rate for Payer: WEA Trust Commercial |
$4,518.23
|
| Rate for Payer: WPS Commercial |
$6,084.60
|
|
|
KIT MATERNITY LATEX FREE
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2963265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
KIT MATERNITY LATEX FREE
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2963265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
KIT MICRO-PUNCTURE 4FR 15 CM
|
Facility
|
IP
|
$5,796.00
|
|
| Hospital Charge Code |
2973606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,953.64 |
| Max. Negotiated Rate |
$5,545.61 |
| Rate for Payer: Aetna Commercial |
$5,425.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.76
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,545.61
|
| Rate for Payer: Health EOS Commercial |
$5,364.78
|
| Rate for Payer: HFN Commercial |
$5,545.61
|
| Rate for Payer: Multiplan Commercial |
$4,822.27
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.64
|
| Rate for Payer: Quartz Commercial |
$3,616.70
|
| Rate for Payer: WEA Trust Commercial |
$3,315.31
|
| Rate for Payer: WPS Commercial |
$4,464.66
|
|
|
KIT MICRO-PUNCTURE 4FR 15 CM
|
Facility
|
OP
|
$5,796.00
|
|
| Hospital Charge Code |
2973606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,687.80 |
| Max. Negotiated Rate |
$5,545.61 |
| Rate for Payer: Aetna Commercial |
$5,425.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,687.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,918.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,013.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,893.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.76
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,545.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,373.27
|
| Rate for Payer: Health EOS Commercial |
$5,364.78
|
| Rate for Payer: HFN Commercial |
$5,545.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,520.88
|
| Rate for Payer: Multiplan Commercial |
$4,822.27
|
| Rate for Payer: NAPHCARE Commercial |
$3,616.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.64
|
| Rate for Payer: Quartz Commercial |
$3,918.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,616.70
|
| Rate for Payer: The Alliance Commercial |
$3,013.92
|
| Rate for Payer: WEA Trust Commercial |
$3,315.31
|
| Rate for Payer: WPS Commercial |
$4,464.66
|
|
|
KIT MICROSMOOTH SLEEVE 8065750517
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
2964172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.04 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Aetna Managed Medicare |
$237.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$550.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$423.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$406.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.75
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$634.92
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: NAPHCARE Commercial |
$507.94
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$550.26
|
| Rate for Payer: Quartz Medicare Advantage |
$507.94
|
| Rate for Payer: The Alliance Commercial |
$423.28
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
KIT MICROSMOOTH SLEEVE 8065750517
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
2964172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.81 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$507.94
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
KIT MONOPTY BIOPSY 16 GA
|
Facility
|
OP
|
$1,238.00
|
|
| Hospital Charge Code |
2962993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.51 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$360.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$836.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$643.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$618.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.64
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$772.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$836.89
|
| Rate for Payer: Quartz Medicare Advantage |
$772.51
|
| Rate for Payer: The Alliance Commercial |
$643.76
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
KIT MONOPTY BIOPSY 16 GA
|
Facility
|
IP
|
$1,238.00
|
|
| Hospital Charge Code |
2962993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.88 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$772.51
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
KIT NANONEEDLE HIGH FLOW CT 125MM AR-3210-0052
|
Facility
|
IP
|
$2,355.00
|
|
| Hospital Charge Code |
6234126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.11 |
| Max. Negotiated Rate |
$2,253.26 |
| Rate for Payer: Aetna Commercial |
$2,204.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,106.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.08
|
| Rate for Payer: Cash Price |
$706.50
|
| Rate for Payer: Cigna Commercial |
$2,253.26
|
| Rate for Payer: Health EOS Commercial |
$2,179.79
|
| Rate for Payer: HFN Commercial |
$2,253.26
|
| Rate for Payer: Multiplan Commercial |
$1,959.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,253.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.11
|
| Rate for Payer: Quartz Commercial |
$1,469.52
|
| Rate for Payer: WEA Trust Commercial |
$1,347.06
|
| Rate for Payer: WPS Commercial |
$1,814.06
|
|
|
KIT NANONEEDLE HIGH FLOW CT 125MM AR-3210-0052
|
Facility
|
OP
|
$2,355.00
|
|
| Hospital Charge Code |
6234126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.78 |
| Max. Negotiated Rate |
$2,253.26 |
| Rate for Payer: Aetna Commercial |
$2,204.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,106.31
|
| Rate for Payer: Aetna Managed Medicare |
$685.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,591.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,224.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,175.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.08
|
| Rate for Payer: Cash Price |
$706.50
|
| Rate for Payer: Cigna Commercial |
$2,253.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,370.61
|
| Rate for Payer: Health EOS Commercial |
$2,179.79
|
| Rate for Payer: HFN Commercial |
$2,253.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,836.90
|
| Rate for Payer: Multiplan Commercial |
$1,959.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,469.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,253.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.11
|
| Rate for Payer: Quartz Commercial |
$1,591.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,469.52
|
| Rate for Payer: The Alliance Commercial |
$1,224.60
|
| Rate for Payer: WEA Trust Commercial |
$1,347.06
|
| Rate for Payer: WPS Commercial |
$1,814.06
|
|
|
KIT NEBULIZER AERONEB SOLO ADULT 06-AG-AS3350-US
|
Facility
|
IP
|
$811.00
|
|
| Hospital Charge Code |
4594778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.29 |
| Max. Negotiated Rate |
$775.96 |
| Rate for Payer: Aetna Commercial |
$759.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.02
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$775.96
|
| Rate for Payer: Health EOS Commercial |
$750.66
|
| Rate for Payer: HFN Commercial |
$775.96
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: Preferred Network Access Commercial |
$775.96
|
| Rate for Payer: Quartz Beloit One Network |
$413.29
|
| Rate for Payer: Quartz Commercial |
$506.06
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$624.71
|
|
|
KIT NEBULIZER AERONEB SOLO ADULT 06-AG-AS3350-US
|
Facility
|
OP
|
$811.00
|
|
| Hospital Charge Code |
4594778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.16 |
| Max. Negotiated Rate |
$775.96 |
| Rate for Payer: Aetna Commercial |
$759.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| Rate for Payer: Aetna Managed Medicare |
$236.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$548.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.02
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$775.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$472.00
|
| Rate for Payer: Health EOS Commercial |
$750.66
|
| Rate for Payer: HFN Commercial |
$775.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.58
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: NAPHCARE Commercial |
$506.06
|
| Rate for Payer: Preferred Network Access Commercial |
$775.96
|
| Rate for Payer: Quartz Beloit One Network |
$413.29
|
| Rate for Payer: Quartz Commercial |
$548.24
|
| Rate for Payer: Quartz Medicare Advantage |
$506.06
|
| Rate for Payer: The Alliance Commercial |
$421.72
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$624.71
|
|
|
KIT NEPHROSTOMY 10.2FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17156
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5384649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$767.89 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Aetna Managed Medicare |
$767.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.73
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,056.86
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,782.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.49
|
| Rate for Payer: The Alliance Commercial |
$1,371.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
KIT NEPHROSTOMY 10.2FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17156
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5384649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,343.82 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,645.49
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
KIT NEPHROSTOMY 8.5FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17155
|
Facility
|
IP
|
$2,758.00
|
|
|
Service Code
|
HCPCS C2627
|
| Hospital Charge Code |
5306821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,405.48 |
| Max. Negotiated Rate |
$2,638.85 |
| Rate for Payer: Aetna Commercial |
$2,581.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.21
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,638.85
|
| Rate for Payer: Health EOS Commercial |
$2,552.80
|
| Rate for Payer: HFN Commercial |
$2,638.85
|
| Rate for Payer: Multiplan Commercial |
$2,294.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.48
|
| Rate for Payer: Quartz Commercial |
$1,720.99
|
| Rate for Payer: WEA Trust Commercial |
$1,577.58
|
| Rate for Payer: WPS Commercial |
$2,124.49
|
|
