|
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
|
|
|
KIT NEVER TOUCH 65CM 11402002
|
Facility
|
OP
|
$5,433.00
|
|
| Hospital Charge Code |
2964098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,582.09 |
| Max. Negotiated Rate |
$5,198.29 |
| Rate for Payer: Aetna Commercial |
$5,085.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,859.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,672.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,825.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,712.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,994.67
|
| Rate for Payer: Cash Price |
$1,629.90
|
| Rate for Payer: Cigna Commercial |
$5,198.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,162.01
|
| Rate for Payer: Health EOS Commercial |
$5,028.78
|
| Rate for Payer: HFN Commercial |
$5,198.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,237.74
|
| Rate for Payer: Multiplan Commercial |
$4,520.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,390.19
|
| Rate for Payer: Preferred Network Access Commercial |
$5,198.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,768.66
|
| Rate for Payer: Quartz Commercial |
$3,672.71
|
| Rate for Payer: Quartz Medicare Advantage |
$3,390.19
|
| Rate for Payer: The Alliance Commercial |
$2,825.16
|
| Rate for Payer: WEA Trust Commercial |
$3,107.68
|
| Rate for Payer: WPS Commercial |
$4,185.04
|
|
|
KIT NEVER TOUCH 65CM 11402002
|
Facility
|
IP
|
$5,433.00
|
|
| Hospital Charge Code |
2964098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,768.66 |
| Max. Negotiated Rate |
$5,198.29 |
| Rate for Payer: Aetna Commercial |
$5,085.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,859.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,994.67
|
| Rate for Payer: Cash Price |
$1,629.90
|
| Rate for Payer: Cigna Commercial |
$5,198.29
|
| Rate for Payer: Health EOS Commercial |
$5,028.78
|
| Rate for Payer: HFN Commercial |
$5,198.29
|
| Rate for Payer: Multiplan Commercial |
$4,520.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,198.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,768.66
|
| Rate for Payer: Quartz Commercial |
$3,390.19
|
| Rate for Payer: WEA Trust Commercial |
$3,107.68
|
| Rate for Payer: WPS Commercial |
$4,185.04
|
|
|
KIT NOVADAQ PINPOINT PAQ PP9036
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5074901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$916.77 |
| Max. Negotiated Rate |
$1,721.28 |
| Rate for Payer: Aetna Commercial |
$1,683.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$991.61
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cigna Commercial |
$1,721.28
|
| Rate for Payer: Health EOS Commercial |
$1,665.15
|
| Rate for Payer: HFN Commercial |
$1,721.28
|
| Rate for Payer: Multiplan Commercial |
$1,496.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,721.28
|
| Rate for Payer: Quartz Beloit One Network |
$916.77
|
| Rate for Payer: Quartz Commercial |
$1,122.58
|
| Rate for Payer: WEA Trust Commercial |
$1,029.03
|
| Rate for Payer: WPS Commercial |
$1,385.77
|
|
|
KIT NOVADAQ PINPOINT PAQ PP9036
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5074901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$1,721.28 |
| Rate for Payer: Aetna Commercial |
$1,683.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.03
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,216.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$935.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$898.06
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$991.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cash Price |
$539.70
|
| Rate for Payer: Cigna Commercial |
$1,721.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,047.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,665.15
|
| Rate for Payer: HFN Commercial |
$1,721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,496.77
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,721.28
|
| Rate for Payer: Quartz Beloit One Network |
$916.77
|
| Rate for Payer: Quartz Commercial |
$1,216.12
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$1,029.03
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,385.77
|
|
|
KIT NOVADAQ SPY PHI WITH INDOCYANINE GREEN/DRAPE HH9006
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5496799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
KIT NOVADAQ SPY PHI WITH INDOCYANINE GREEN/DRAPE HH9006
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C9733
|
| Hospital Charge Code |
5496799
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
KIT PARS SUTURE IMPLANT AR-8860DS
|
Facility
|
IP
|
$5,702.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,905.74 |
| Max. Negotiated Rate |
$5,455.67 |
| Rate for Payer: Aetna Commercial |
$5,337.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,099.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.94
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$5,455.67
|
| Rate for Payer: Health EOS Commercial |
$5,277.77
|
| Rate for Payer: HFN Commercial |
$5,455.67
|
| Rate for Payer: Multiplan Commercial |
$4,744.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,455.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.74
|
| Rate for Payer: Quartz Commercial |
$3,558.05
|
| Rate for Payer: WEA Trust Commercial |
$3,261.54
|
| Rate for Payer: WPS Commercial |
$4,392.25
|
|
|
KIT PARS SUTURE IMPLANT AR-8860DS
|
Facility
|
OP
|
$5,702.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.42 |
| Max. Negotiated Rate |
$5,455.67 |
| Rate for Payer: Aetna Commercial |
$5,337.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,099.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,660.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,854.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,965.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,846.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.94
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$5,455.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,318.56
|
| Rate for Payer: Health EOS Commercial |
$5,277.77
|
| Rate for Payer: HFN Commercial |
$5,455.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,447.56
|
| Rate for Payer: Multiplan Commercial |
$4,744.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,558.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,455.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.74
|
| Rate for Payer: Quartz Commercial |
$3,854.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,558.05
|
| Rate for Payer: The Alliance Commercial |
$2,965.04
|
| Rate for Payer: WEA Trust Commercial |
$3,261.54
|
| Rate for Payer: WPS Commercial |
$4,392.25
|
|
|
KIT PCNL PERCUTANEOUS TRACT WITH ZIPWIRE M0064501140
|
Facility
|
OP
|
$5,440.00
|
|
| Hospital Charge Code |
5306819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.13 |
| Max. Negotiated Rate |
$5,204.99 |
| Rate for Payer: Aetna Commercial |
$5,091.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,584.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,677.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,828.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,715.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.53
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$5,204.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,166.08
|
| Rate for Payer: Health EOS Commercial |
$5,035.26
|
| Rate for Payer: HFN Commercial |
$5,204.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,243.20
|
| Rate for Payer: Multiplan Commercial |
$4,526.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,394.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,772.22
|
| Rate for Payer: Quartz Commercial |
$3,677.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,394.56
|
| Rate for Payer: The Alliance Commercial |
$2,828.80
|
| Rate for Payer: WEA Trust Commercial |
$3,111.68
|
| Rate for Payer: WPS Commercial |
$4,190.43
|
|
|
KIT PCNL PERCUTANEOUS TRACT WITH ZIPWIRE M0064501140
|
Facility
|
IP
|
$5,440.00
|
|
| Hospital Charge Code |
5306819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,772.22 |
| Max. Negotiated Rate |
$5,204.99 |
| Rate for Payer: Aetna Commercial |
$5,091.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.53
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$5,204.99
|
| Rate for Payer: Health EOS Commercial |
$5,035.26
|
| Rate for Payer: HFN Commercial |
$5,204.99
|
| Rate for Payer: Multiplan Commercial |
$4,526.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,772.22
|
| Rate for Payer: Quartz Commercial |
$3,394.56
|
| Rate for Payer: WEA Trust Commercial |
$3,111.68
|
| Rate for Payer: WPS Commercial |
$4,190.43
|
|
|
KIT PD CATHETER PRE-STERNAL 8888121132
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
4520281
|
|
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 PD CATHETER PRE-STERNAL 8888121132
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
4520281
|
|
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 PERC INSERT FOR 3.0 KNOTLESS ST AR-1938PK
|
Facility
|
IP
|
$3,897.00
|
|
| Hospital Charge Code |
5611599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,985.91 |
| Max. Negotiated Rate |
$3,728.65 |
| Rate for Payer: Aetna Commercial |
$3,647.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,485.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,148.03
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,728.65
|
| Rate for Payer: Health EOS Commercial |
$3,607.06
|
| Rate for Payer: HFN Commercial |
$3,728.65
|
| Rate for Payer: Multiplan Commercial |
$3,242.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,728.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,985.91
|
| Rate for Payer: Quartz Commercial |
$2,431.73
|
| Rate for Payer: WEA Trust Commercial |
$2,229.08
|
| Rate for Payer: WPS Commercial |
$3,001.86
|
|
|
KIT PERC INSERT FOR 3.0 KNOTLESS ST AR-1938PK
|
Facility
|
OP
|
$3,897.00
|
|
| Hospital Charge Code |
5611599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,134.81 |
| Max. Negotiated Rate |
$3,728.65 |
| Rate for Payer: Aetna Commercial |
$3,647.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,485.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,134.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,634.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,026.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,945.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,148.03
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,728.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,268.05
|
| Rate for Payer: Health EOS Commercial |
$3,607.06
|
| Rate for Payer: HFN Commercial |
$3,728.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,039.66
|
| Rate for Payer: Multiplan Commercial |
$3,242.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,431.73
|
| Rate for Payer: Preferred Network Access Commercial |
$3,728.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,985.91
|
| Rate for Payer: Quartz Commercial |
$2,634.37
|
| Rate for Payer: Quartz Medicare Advantage |
$2,431.73
|
| Rate for Payer: The Alliance Commercial |
$2,026.44
|
| Rate for Payer: WEA Trust Commercial |
$2,229.08
|
| Rate for Payer: WPS Commercial |
$3,001.86
|
|
|
KIT PERCUTANEOUS EXTENSION INTERSTIM SURESCAN MRI (RECHARGE FREE) 3560022
|
Facility
|
OP
|
$2,557.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
5603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Aetna Managed Medicare |
$744.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.17
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.46
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,728.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.57
|
| Rate for Payer: The Alliance Commercial |
$1,329.64
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
KIT PERCUTANEOUS EXTENSION INTERSTIM SURESCAN MRI (RECHARGE FREE) 3560022
|
Facility
|
IP
|
$2,557.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
5603548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.05 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,595.57
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
KIT PERCUTANEOUS SHEATH 8.5fr AK-09803
|
Facility
|
IP
|
$547.00
|
|
| Hospital Charge Code |
2962966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
KIT PERCUTANEOUS SHEATH 8.5fr AK-09803
|
Facility
|
OP
|
$547.00
|
|
| Hospital Charge Code |
2962966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.29 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$273.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$284.44
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
KIT PERICARDIAL CENTISIS 8.3FR #M00443051***DISC 3/23
|
Facility
|
OP
|
$2,338.00
|
|
| Hospital Charge Code |
2973600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.83 |
| Max. Negotiated Rate |
$2,237.00 |
| Rate for Payer: Aetna Commercial |
$2,188.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,091.11
|
| Rate for Payer: Aetna Managed Medicare |
$680.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,580.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,215.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,167.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,288.71
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cigna Commercial |
$2,237.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,360.72
|
| Rate for Payer: Health EOS Commercial |
$2,164.05
|
| Rate for Payer: HFN Commercial |
$2,237.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,823.64
|
| Rate for Payer: Multiplan Commercial |
$1,945.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,458.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,237.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.44
|
| Rate for Payer: Quartz Commercial |
$1,580.49
|
| Rate for Payer: Quartz Medicare Advantage |
$1,458.91
|
| Rate for Payer: The Alliance Commercial |
$1,215.76
|
| Rate for Payer: WEA Trust Commercial |
$1,337.34
|
| Rate for Payer: WPS Commercial |
$1,800.96
|
|
|
KIT PERICARDIAL CENTISIS 8.3FR #M00443051***DISC 3/23
|
Facility
|
IP
|
$2,338.00
|
|
| Hospital Charge Code |
2973600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.44 |
| Max. Negotiated Rate |
$2,237.00 |
| Rate for Payer: Aetna Commercial |
$2,188.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,091.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,288.71
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cigna Commercial |
$2,237.00
|
| Rate for Payer: Health EOS Commercial |
$2,164.05
|
| Rate for Payer: HFN Commercial |
$2,237.00
|
| Rate for Payer: Multiplan Commercial |
$1,945.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,237.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.44
|
| Rate for Payer: Quartz Commercial |
$1,458.91
|
| Rate for Payer: WEA Trust Commercial |
$1,337.34
|
| Rate for Payer: WPS Commercial |
$1,800.96
|
|
|
KIT PERI PATCH REPAIR #8888285001
|
Facility
|
OP
|
$1,119.00
|
|
| Hospital Charge Code |
2974668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$325.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$756.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.26
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.82
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$698.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$756.44
|
| Rate for Payer: Quartz Medicare Advantage |
$698.26
|
| Rate for Payer: The Alliance Commercial |
$581.88
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
KIT PERI PATCH REPAIR #8888285001
|
Facility
|
IP
|
$1,119.00
|
|
| Hospital Charge Code |
2974668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.24 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$698.26
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
KIT PERITONEAL LAVAGE-ARROW
|
Facility
|
OP
|
$693.00
|
|
| Hospital Charge Code |
2962994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$663.06 |
| Rate for Payer: Aetna Commercial |
$648.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Managed Medicare |
$201.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.98
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$663.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.33
|
| Rate for Payer: Health EOS Commercial |
$641.44
|
| Rate for Payer: HFN Commercial |
$663.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.54
|
| Rate for Payer: Multiplan Commercial |
$576.58
|
| Rate for Payer: NAPHCARE Commercial |
$432.43
|
| Rate for Payer: Preferred Network Access Commercial |
$663.06
|
| Rate for Payer: Quartz Beloit One Network |
$353.15
|
| Rate for Payer: Quartz Commercial |
$468.47
|
| Rate for Payer: Quartz Medicare Advantage |
$432.43
|
| Rate for Payer: The Alliance Commercial |
$360.36
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: WPS Commercial |
$533.82
|
|
|
KIT PERITONEAL LAVAGE-ARROW
|
Facility
|
IP
|
$693.00
|
|
| Hospital Charge Code |
2962994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.15 |
| Max. Negotiated Rate |
$663.06 |
| Rate for Payer: Aetna Commercial |
$648.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.98
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$663.06
|
| Rate for Payer: Health EOS Commercial |
$641.44
|
| Rate for Payer: HFN Commercial |
$663.06
|
| Rate for Payer: Multiplan Commercial |
$576.58
|
| Rate for Payer: Preferred Network Access Commercial |
$663.06
|
| Rate for Payer: Quartz Beloit One Network |
$353.15
|
| Rate for Payer: Quartz Commercial |
$432.43
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: WPS Commercial |
$533.82
|
|
