|
NEEDLE POLYESTER DOUBLE ARMED
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
2964930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.96 |
| Max. Negotiated Rate |
$2,728.00 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Aetna Managed Medicare |
$190.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.65
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.50
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$443.30
|
| Rate for Payer: Quartz Medicare Advantage |
$409.20
|
| Rate for Payer: The Alliance Commercial |
$2,728.00
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
NEEDLE PROCORE ECHO-HD-22-EBUS-O-C G34281
|
Facility
|
OP
|
$2,843.00
|
|
| Hospital Charge Code |
5384683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$796.04 |
| Max. Negotiated Rate |
$11,372.00 |
| Rate for Payer: Aetna Commercial |
$2,558.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,444.98
|
| Rate for Payer: Aetna Managed Medicare |
$796.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,847.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,421.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,364.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,506.79
|
| Rate for Payer: Cash Price |
$852.90
|
| Rate for Payer: Cigna Commercial |
$2,615.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,590.94
|
| Rate for Payer: Health EOS Commercial |
$2,530.27
|
| Rate for Payer: HFN Commercial |
$2,615.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,132.25
|
| Rate for Payer: Multiplan Commercial |
$2,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,705.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,615.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.07
|
| Rate for Payer: Quartz Commercial |
$1,847.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,705.80
|
| Rate for Payer: The Alliance Commercial |
$11,372.00
|
| Rate for Payer: WEA Trust Commercial |
$1,563.65
|
| Rate for Payer: WPS Commercial |
$2,105.81
|
|
|
NEEDLE PROCORE ECHO-HD-22-EBUS-O-C G34281
|
Facility
|
IP
|
$2,843.00
|
|
| Hospital Charge Code |
5384683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,393.07 |
| Max. Negotiated Rate |
$2,615.56 |
| Rate for Payer: Aetna Commercial |
$2,558.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,444.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,506.79
|
| Rate for Payer: Cash Price |
$852.90
|
| Rate for Payer: Cigna Commercial |
$2,615.56
|
| Rate for Payer: Health EOS Commercial |
$2,530.27
|
| Rate for Payer: HFN Commercial |
$2,615.56
|
| Rate for Payer: Multiplan Commercial |
$2,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,705.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,615.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.07
|
| Rate for Payer: Quartz Commercial |
$1,705.80
|
| Rate for Payer: WEA Trust Commercial |
$1,563.65
|
| Rate for Payer: WPS Commercial |
$2,105.81
|
|
|
NEEDLE RETROBULBAR 23G X 1 1/4 585001
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
6172536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
NEEDLE RETROBULBAR 23G X 1 1/4 585001
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
6172536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
NEEDLE RETROBULBAR 23G X 1.5 581638
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
2968991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
NEEDLE RETROBULBAR 23G X 1.5 581638
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
2968991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
NEEDLE RIDGED 16GA-25GA X 25CM 17DEG TIP PROLARYN 9010MO
|
Facility
|
OP
|
$923.00
|
|
| Hospital Charge Code |
6181259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$3,692.00 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.78
|
| Rate for Payer: Aetna Managed Medicare |
$258.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.19
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$849.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.51
|
| Rate for Payer: Health EOS Commercial |
$821.47
|
| Rate for Payer: HFN Commercial |
$849.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.25
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: NAPHCARE Commercial |
$553.80
|
| Rate for Payer: Preferred Network Access Commercial |
$849.16
|
| Rate for Payer: Quartz Beloit One Network |
$452.27
|
| Rate for Payer: Quartz Commercial |
$599.95
|
| Rate for Payer: Quartz Medicare Advantage |
$553.80
|
| Rate for Payer: The Alliance Commercial |
$3,692.00
|
| Rate for Payer: WEA Trust Commercial |
$507.65
|
| Rate for Payer: WPS Commercial |
$683.67
|
|
|
NEEDLE RIDGED 16GA-25GA X 25CM 17DEG TIP PROLARYN 9010MO
|
Facility
|
IP
|
$923.00
|
|
| Hospital Charge Code |
6181259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.27 |
| Max. Negotiated Rate |
$849.16 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.19
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$849.16
|
| Rate for Payer: Health EOS Commercial |
$821.47
|
| Rate for Payer: HFN Commercial |
$849.16
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: NAPHCARE Commercial |
$553.80
|
| Rate for Payer: Preferred Network Access Commercial |
$849.16
|
| Rate for Payer: Quartz Beloit One Network |
$452.27
|
| Rate for Payer: Quartz Commercial |
$553.80
|
| Rate for Payer: WEA Trust Commercial |
$507.65
|
| Rate for Payer: WPS Commercial |
$683.67
|
|
|
NEEDLE RIDGED 25GA X 1.5 HUBER TIP PROLARYN 9001MO
|
Facility
|
IP
|
$923.00
|
|
| Hospital Charge Code |
6181261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.27 |
| Max. Negotiated Rate |
$849.16 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.19
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$849.16
|
| Rate for Payer: Health EOS Commercial |
$821.47
|
| Rate for Payer: HFN Commercial |
$849.16
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: NAPHCARE Commercial |
$553.80
|
| Rate for Payer: Preferred Network Access Commercial |
$849.16
|
| Rate for Payer: Quartz Beloit One Network |
$452.27
|
| Rate for Payer: Quartz Commercial |
$553.80
|
| Rate for Payer: WEA Trust Commercial |
$507.65
|
| Rate for Payer: WPS Commercial |
$683.67
|
|
|
NEEDLE RIDGED 25GA X 1.5 HUBER TIP PROLARYN 9001MO
|
Facility
|
OP
|
$923.00
|
|
| Hospital Charge Code |
6181261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$3,692.00 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.78
|
| Rate for Payer: Aetna Managed Medicare |
$258.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.19
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$849.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.51
|
| Rate for Payer: Health EOS Commercial |
$821.47
|
| Rate for Payer: HFN Commercial |
$849.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.25
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: NAPHCARE Commercial |
$553.80
|
| Rate for Payer: Preferred Network Access Commercial |
$849.16
|
| Rate for Payer: Quartz Beloit One Network |
$452.27
|
| Rate for Payer: Quartz Commercial |
$599.95
|
| Rate for Payer: Quartz Medicare Advantage |
$553.80
|
| Rate for Payer: The Alliance Commercial |
$3,692.00
|
| Rate for Payer: WEA Trust Commercial |
$507.65
|
| Rate for Payer: WPS Commercial |
$683.67
|
|
|
NEEDLE SCORPION AR-13990N
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
2964665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
NEEDLE SCORPION AR-13990N
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
2964665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
NEEDLE SCORPION CAPSULECLOSE HIP AR-16992N
|
Facility
|
OP
|
$4,425.00
|
|
| Hospital Charge Code |
5496759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,239.00 |
| Max. Negotiated Rate |
$17,700.00 |
| Rate for Payer: Aetna Commercial |
$3,982.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,212.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.25
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Cigna Commercial |
$4,071.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.23
|
| Rate for Payer: Health EOS Commercial |
$3,938.25
|
| Rate for Payer: HFN Commercial |
$4,071.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,318.75
|
| Rate for Payer: Multiplan Commercial |
$3,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.25
|
| Rate for Payer: Quartz Commercial |
$2,876.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.00
|
| Rate for Payer: The Alliance Commercial |
$17,700.00
|
| Rate for Payer: WEA Trust Commercial |
$2,433.75
|
| Rate for Payer: WPS Commercial |
$3,277.60
|
|
|
NEEDLE SCORPION CAPSULECLOSE HIP AR-16992N
|
Facility
|
IP
|
$4,425.00
|
|
| Hospital Charge Code |
5496759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,168.25 |
| Max. Negotiated Rate |
$4,071.00 |
| Rate for Payer: Aetna Commercial |
$3,982.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.25
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Cigna Commercial |
$4,071.00
|
| Rate for Payer: Health EOS Commercial |
$3,938.25
|
| Rate for Payer: HFN Commercial |
$4,071.00
|
| Rate for Payer: Multiplan Commercial |
$3,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.25
|
| Rate for Payer: Quartz Commercial |
$2,655.00
|
| Rate for Payer: WEA Trust Commercial |
$2,433.75
|
| Rate for Payer: WPS Commercial |
$3,277.60
|
|
|
NEEDLE SCORPION HIP AR-16991N
|
Facility
|
OP
|
$2,969.00
|
|
| Hospital Charge Code |
5349215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.32 |
| Max. Negotiated Rate |
$11,876.00 |
| Rate for Payer: Aetna Commercial |
$2,672.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,553.34
|
| Rate for Payer: Aetna Managed Medicare |
$831.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,929.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,484.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,425.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.57
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,731.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,661.45
|
| Rate for Payer: Health EOS Commercial |
$2,642.41
|
| Rate for Payer: HFN Commercial |
$2,731.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,226.75
|
| Rate for Payer: Multiplan Commercial |
$2,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,731.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.81
|
| Rate for Payer: Quartz Commercial |
$1,929.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,781.40
|
| Rate for Payer: The Alliance Commercial |
$11,876.00
|
| Rate for Payer: WEA Trust Commercial |
$1,632.95
|
| Rate for Payer: WPS Commercial |
$2,199.14
|
|
|
NEEDLE SCORPION HIP AR-16991N
|
Facility
|
IP
|
$2,969.00
|
|
| Hospital Charge Code |
5349215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,454.81 |
| Max. Negotiated Rate |
$2,731.48 |
| Rate for Payer: Aetna Commercial |
$2,672.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,553.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.57
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,731.48
|
| Rate for Payer: Health EOS Commercial |
$2,642.41
|
| Rate for Payer: HFN Commercial |
$2,731.48
|
| Rate for Payer: Multiplan Commercial |
$2,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,731.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.81
|
| Rate for Payer: Quartz Commercial |
$1,781.40
|
| Rate for Payer: WEA Trust Commercial |
$1,632.95
|
| Rate for Payer: WPS Commercial |
$2,199.14
|
|
|
NEEDLE SCORPION KNEE AR-12990N
|
Facility
|
OP
|
$2,972.00
|
|
| Hospital Charge Code |
5106621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$832.16 |
| Max. Negotiated Rate |
$11,888.00 |
| Rate for Payer: Aetna Commercial |
$2,674.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,555.92
|
| Rate for Payer: Aetna Managed Medicare |
$832.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,931.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,426.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,575.16
|
| Rate for Payer: Cash Price |
$891.60
|
| Rate for Payer: Cigna Commercial |
$2,734.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,663.13
|
| Rate for Payer: Health EOS Commercial |
$2,645.08
|
| Rate for Payer: HFN Commercial |
$2,734.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,229.00
|
| Rate for Payer: Multiplan Commercial |
$2,377.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,783.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,734.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,456.28
|
| Rate for Payer: Quartz Commercial |
$1,931.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,783.20
|
| Rate for Payer: The Alliance Commercial |
$11,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,634.60
|
| Rate for Payer: WPS Commercial |
$2,201.36
|
|
|
NEEDLE SCORPION KNEE AR-12990N
|
Facility
|
IP
|
$2,972.00
|
|
| Hospital Charge Code |
5106621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,456.28 |
| Max. Negotiated Rate |
$2,734.24 |
| Rate for Payer: Aetna Commercial |
$2,674.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,555.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,575.16
|
| Rate for Payer: Cash Price |
$891.60
|
| Rate for Payer: Cigna Commercial |
$2,734.24
|
| Rate for Payer: Health EOS Commercial |
$2,645.08
|
| Rate for Payer: HFN Commercial |
$2,734.24
|
| Rate for Payer: Multiplan Commercial |
$2,377.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,783.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,734.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,456.28
|
| Rate for Payer: Quartz Commercial |
$1,783.20
|
| Rate for Payer: WEA Trust Commercial |
$1,634.60
|
| Rate for Payer: WPS Commercial |
$2,201.36
|
|
|
NEEDLE SCORPION MULTI-FIRE AR-13995N
|
Facility
|
OP
|
$2,591.00
|
|
| Hospital Charge Code |
4520130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.48 |
| Max. Negotiated Rate |
$10,364.00 |
| Rate for Payer: Aetna Commercial |
$2,331.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.26
|
| Rate for Payer: Aetna Managed Medicare |
$725.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,684.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,243.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.23
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,383.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,449.92
|
| Rate for Payer: Health EOS Commercial |
$2,305.99
|
| Rate for Payer: HFN Commercial |
$2,383.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,943.25
|
| Rate for Payer: Multiplan Commercial |
$2,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.59
|
| Rate for Payer: Quartz Commercial |
$1,684.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,554.60
|
| Rate for Payer: The Alliance Commercial |
$10,364.00
|
| Rate for Payer: WEA Trust Commercial |
$1,425.05
|
| Rate for Payer: WPS Commercial |
$1,919.15
|
|
|
NEEDLE SCORPION MULTI-FIRE AR-13995N
|
Facility
|
IP
|
$2,591.00
|
|
| Hospital Charge Code |
4520130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,269.59 |
| Max. Negotiated Rate |
$2,383.72 |
| Rate for Payer: Aetna Commercial |
$2,331.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.23
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,383.72
|
| Rate for Payer: Health EOS Commercial |
$2,305.99
|
| Rate for Payer: HFN Commercial |
$2,383.72
|
| Rate for Payer: Multiplan Commercial |
$2,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.59
|
| Rate for Payer: Quartz Commercial |
$1,554.60
|
| Rate for Payer: WEA Trust Commercial |
$1,425.05
|
| Rate for Payer: WPS Commercial |
$1,919.15
|
|
|
NEEDLE SCORPION SUREFIRE
|
Facility
|
IP
|
$3,172.00
|
|
| Hospital Charge Code |
2964691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,554.28 |
| Max. Negotiated Rate |
$2,918.24 |
| Rate for Payer: Aetna Commercial |
$2,854.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,681.16
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$2,918.24
|
| Rate for Payer: Health EOS Commercial |
$2,823.08
|
| Rate for Payer: HFN Commercial |
$2,918.24
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,918.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.28
|
| Rate for Payer: Quartz Commercial |
$1,903.20
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.50
|
|
|
NEEDLE SCORPION SUREFIRE
|
Facility
|
OP
|
$3,172.00
|
|
| Hospital Charge Code |
2964691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.16 |
| Max. Negotiated Rate |
$12,688.00 |
| Rate for Payer: Aetna Commercial |
$2,854.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Aetna Managed Medicare |
$888.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,681.16
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$2,918.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,775.05
|
| Rate for Payer: Health EOS Commercial |
$2,823.08
|
| Rate for Payer: HFN Commercial |
$2,918.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,379.00
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,918.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.28
|
| Rate for Payer: Quartz Commercial |
$2,061.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,903.20
|
| Rate for Payer: The Alliance Commercial |
$12,688.00
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.50
|
|
|
NEEDLE SET 21 GA X 3.4 367281
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
2963564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.50
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Quartz Medicare Advantage |
$25.20
|
| Rate for Payer: The Alliance Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
NEEDLE SET 21 GA X 3.4 367281
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
2963564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
