|
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 |
$470.36 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Aetna Commercial |
$863.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$825.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.76
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$883.13
|
| Rate for Payer: Health EOS Commercial |
$854.33
|
| Rate for Payer: HFN Commercial |
$883.13
|
| Rate for Payer: Multiplan Commercial |
$767.94
|
| Rate for Payer: Preferred Network Access Commercial |
$883.13
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$575.95
|
| Rate for Payer: WEA Trust Commercial |
$527.96
|
| Rate for Payer: WPS Commercial |
$710.99
|
|
|
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 |
$470.36 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Aetna Commercial |
$863.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$825.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.76
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$883.13
|
| Rate for Payer: Health EOS Commercial |
$854.33
|
| Rate for Payer: HFN Commercial |
$883.13
|
| Rate for Payer: Multiplan Commercial |
$767.94
|
| Rate for Payer: Preferred Network Access Commercial |
$883.13
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$575.95
|
| Rate for Payer: WEA Trust Commercial |
$527.96
|
| Rate for Payer: WPS Commercial |
$710.99
|
|
|
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 |
$268.78 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Aetna Commercial |
$863.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$825.53
|
| Rate for Payer: Aetna Managed Medicare |
$268.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.76
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$883.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.19
|
| Rate for Payer: Health EOS Commercial |
$854.33
|
| Rate for Payer: HFN Commercial |
$883.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.94
|
| Rate for Payer: Multiplan Commercial |
$767.94
|
| Rate for Payer: NAPHCARE Commercial |
$575.95
|
| Rate for Payer: Preferred Network Access Commercial |
$883.13
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$623.95
|
| Rate for Payer: Quartz Medicare Advantage |
$575.95
|
| Rate for Payer: The Alliance Commercial |
$479.96
|
| Rate for Payer: WEA Trust Commercial |
$527.96
|
| Rate for Payer: WPS Commercial |
$710.99
|
|
|
NEEDLE SCORPION AR-13990N
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
2964665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.34 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Aetna Managed Medicare |
$670.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.76
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.56
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,556.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.45
|
| Rate for Payer: The Alliance Commercial |
$1,197.04
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
NEEDLE SCORPION AR-13990N
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
2964665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.10 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,436.45
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
NEEDLE SCORPION CAPSULECLOSE HIP AR-16992N
|
Facility
|
IP
|
$4,425.00
|
|
| Hospital Charge Code |
5496759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,254.98 |
| Max. Negotiated Rate |
$4,233.84 |
| Rate for Payer: Aetna Commercial |
$4,141.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,957.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.06
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Cigna Commercial |
$4,233.84
|
| Rate for Payer: Health EOS Commercial |
$4,095.78
|
| Rate for Payer: HFN Commercial |
$4,233.84
|
| Rate for Payer: Multiplan Commercial |
$3,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,233.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.98
|
| Rate for Payer: Quartz Commercial |
$2,761.20
|
| Rate for Payer: WEA Trust Commercial |
$2,531.10
|
| Rate for Payer: WPS Commercial |
$3,408.58
|
|
|
NEEDLE SCORPION CAPSULECLOSE HIP AR-16992N
|
Facility
|
OP
|
$4,425.00
|
|
| Hospital Charge Code |
5496759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,288.56 |
| Max. Negotiated Rate |
$4,233.84 |
| Rate for Payer: Aetna Commercial |
$4,141.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,957.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,208.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.06
|
| Rate for Payer: Cash Price |
$1,327.50
|
| Rate for Payer: Cigna Commercial |
$4,233.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.35
|
| Rate for Payer: Health EOS Commercial |
$4,095.78
|
| Rate for Payer: HFN Commercial |
$4,233.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,451.50
|
| Rate for Payer: Multiplan Commercial |
$3,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,233.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.98
|
| Rate for Payer: Quartz Commercial |
$2,991.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,761.20
|
| Rate for Payer: The Alliance Commercial |
$2,301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,531.10
|
| Rate for Payer: WPS Commercial |
$3,408.58
|
|
|
NEEDLE SCORPION HIP AR-16991N
|
Facility
|
OP
|
$2,969.00
|
|
| Hospital Charge Code |
5349215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.57 |
| Max. Negotiated Rate |
$2,840.74 |
| Rate for Payer: Aetna Commercial |
$2,778.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,655.47
|
| Rate for Payer: Aetna Managed Medicare |
$864.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,007.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,482.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,636.51
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,840.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,727.96
|
| Rate for Payer: Health EOS Commercial |
$2,748.11
|
| Rate for Payer: HFN Commercial |
$2,840.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,315.82
|
| Rate for Payer: Multiplan Commercial |
$2,470.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,852.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,840.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.00
|
| Rate for Payer: Quartz Commercial |
$2,007.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,852.66
|
| Rate for Payer: The Alliance Commercial |
$1,543.88
|
| Rate for Payer: WEA Trust Commercial |
$1,698.27
|
| Rate for Payer: WPS Commercial |
$2,287.02
|
|
|
NEEDLE SCORPION HIP AR-16991N
|
Facility
|
IP
|
$2,969.00
|
|
| Hospital Charge Code |
5349215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,513.00 |
| Max. Negotiated Rate |
$2,840.74 |
| Rate for Payer: Aetna Commercial |
$2,778.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,655.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,636.51
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,840.74
|
| Rate for Payer: Health EOS Commercial |
$2,748.11
|
| Rate for Payer: HFN Commercial |
$2,840.74
|
| Rate for Payer: Multiplan Commercial |
$2,470.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,840.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.00
|
| Rate for Payer: Quartz Commercial |
$1,852.66
|
| Rate for Payer: WEA Trust Commercial |
$1,698.27
|
| Rate for Payer: WPS Commercial |
$2,287.02
|
|
|
NEEDLE SCORPION KNEE AR-12990N
|
Facility
|
IP
|
$2,972.00
|
|
| Hospital Charge Code |
5106621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,514.53 |
| Max. Negotiated Rate |
$2,843.61 |
| Rate for Payer: Aetna Commercial |
$2,781.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,658.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,638.17
|
| Rate for Payer: Cash Price |
$891.60
|
| Rate for Payer: Cigna Commercial |
$2,843.61
|
| Rate for Payer: Health EOS Commercial |
$2,750.88
|
| Rate for Payer: HFN Commercial |
$2,843.61
|
| Rate for Payer: Multiplan Commercial |
$2,472.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,843.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,514.53
|
| Rate for Payer: Quartz Commercial |
$1,854.53
|
| Rate for Payer: WEA Trust Commercial |
$1,699.98
|
| Rate for Payer: WPS Commercial |
$2,289.33
|
|
|
NEEDLE SCORPION KNEE AR-12990N
|
Facility
|
OP
|
$2,972.00
|
|
| Hospital Charge Code |
5106621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$865.45 |
| Max. Negotiated Rate |
$2,843.61 |
| Rate for Payer: Aetna Commercial |
$2,781.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,658.16
|
| Rate for Payer: Aetna Managed Medicare |
$865.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,009.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,545.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,483.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,638.17
|
| Rate for Payer: Cash Price |
$891.60
|
| Rate for Payer: Cigna Commercial |
$2,843.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,729.70
|
| Rate for Payer: Health EOS Commercial |
$2,750.88
|
| Rate for Payer: HFN Commercial |
$2,843.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,318.16
|
| Rate for Payer: Multiplan Commercial |
$2,472.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,854.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,843.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,514.53
|
| Rate for Payer: Quartz Commercial |
$2,009.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,854.53
|
| Rate for Payer: The Alliance Commercial |
$1,545.44
|
| Rate for Payer: WEA Trust Commercial |
$1,699.98
|
| Rate for Payer: WPS Commercial |
$2,289.33
|
|
|
NEEDLE SCORPION MULTI-FIRE AR-13995N
|
Facility
|
IP
|
$2,591.00
|
|
| Hospital Charge Code |
4520130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.37 |
| Max. Negotiated Rate |
$2,479.07 |
| Rate for Payer: Aetna Commercial |
$2,425.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.16
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,479.07
|
| Rate for Payer: Health EOS Commercial |
$2,398.23
|
| Rate for Payer: HFN Commercial |
$2,479.07
|
| Rate for Payer: Multiplan Commercial |
$2,155.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.37
|
| Rate for Payer: Quartz Commercial |
$1,616.78
|
| Rate for Payer: WEA Trust Commercial |
$1,482.05
|
| Rate for Payer: WPS Commercial |
$1,995.85
|
|
|
NEEDLE SCORPION MULTI-FIRE AR-13995N
|
Facility
|
OP
|
$2,591.00
|
|
| Hospital Charge Code |
4520130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,479.07 |
| Rate for Payer: Aetna Commercial |
$2,425.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.39
|
| Rate for Payer: Aetna Managed Medicare |
$754.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,751.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,347.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,293.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.16
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,479.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,507.96
|
| Rate for Payer: Health EOS Commercial |
$2,398.23
|
| Rate for Payer: HFN Commercial |
$2,479.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,020.98
|
| Rate for Payer: Multiplan Commercial |
$2,155.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,616.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.37
|
| Rate for Payer: Quartz Commercial |
$1,751.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,616.78
|
| Rate for Payer: The Alliance Commercial |
$1,347.32
|
| Rate for Payer: WEA Trust Commercial |
$1,482.05
|
| Rate for Payer: WPS Commercial |
$1,995.85
|
|
|
NEEDLE SCORPION SUREFIRE
|
Facility
|
OP
|
$3,172.00
|
|
| Hospital Charge Code |
2964691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$923.69 |
| Max. Negotiated Rate |
$3,034.97 |
| Rate for Payer: Aetna Commercial |
$2,968.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.04
|
| Rate for Payer: Aetna Managed Medicare |
$923.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,144.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,649.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,583.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.41
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$3,034.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,846.10
|
| Rate for Payer: Health EOS Commercial |
$2,936.00
|
| Rate for Payer: HFN Commercial |
$3,034.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,474.16
|
| Rate for Payer: Multiplan Commercial |
$2,639.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,979.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.45
|
| Rate for Payer: Quartz Commercial |
$2,144.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,979.33
|
| Rate for Payer: The Alliance Commercial |
$1,649.44
|
| Rate for Payer: WEA Trust Commercial |
$1,814.38
|
| Rate for Payer: WPS Commercial |
$2,443.39
|
|
|
NEEDLE SCORPION SUREFIRE
|
Facility
|
IP
|
$3,172.00
|
|
| Hospital Charge Code |
2964691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,616.45 |
| Max. Negotiated Rate |
$3,034.97 |
| Rate for Payer: Aetna Commercial |
$2,968.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.41
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$3,034.97
|
| Rate for Payer: Health EOS Commercial |
$2,936.00
|
| Rate for Payer: HFN Commercial |
$3,034.97
|
| Rate for Payer: Multiplan Commercial |
$2,639.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.45
|
| Rate for Payer: Quartz Commercial |
$1,979.33
|
| Rate for Payer: WEA Trust Commercial |
$1,814.38
|
| Rate for Payer: WPS Commercial |
$2,443.39
|
|
|
NEEDLE SET 21 GA X 3.4 367281
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
2963564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
NEEDLE SET 21 GA X 3.4 367281
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
2963564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.44
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26.21
|
| Rate for Payer: The Alliance Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
NEEDLE SET 23ga X 3/4 12
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2963092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
NEEDLE SET 23ga X 3/4 12
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2963092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
NEEDLE SET ADULT EZ-IO 9001
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2975058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
NEEDLE SET ADULT EZ-IO 9001
|
Facility
|
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2975058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.65 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Aetna Managed Medicare |
$527.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,224.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$942.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$904.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,054.58
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,413.36
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,130.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,224.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,130.69
|
| Rate for Payer: The Alliance Commercial |
$942.24
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
NEEDLE SET BARIATRIC EZ-IO 9079
|
Facility
|
OP
|
$1,754.00
|
|
| Hospital Charge Code |
2975057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$510.76 |
| Max. Negotiated Rate |
$1,678.23 |
| Rate for Payer: Aetna Commercial |
$1,641.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.78
|
| Rate for Payer: Aetna Managed Medicare |
$510.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$912.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.80
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,678.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.83
|
| Rate for Payer: Health EOS Commercial |
$1,623.50
|
| Rate for Payer: HFN Commercial |
$1,678.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.12
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.23
|
| Rate for Payer: Quartz Beloit One Network |
$893.84
|
| Rate for Payer: Quartz Commercial |
$1,185.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,094.50
|
| Rate for Payer: The Alliance Commercial |
$912.08
|
| Rate for Payer: WEA Trust Commercial |
$1,003.29
|
| Rate for Payer: WPS Commercial |
$1,351.11
|
|
|
NEEDLE SET BARIATRIC EZ-IO 9079
|
Facility
|
IP
|
$1,754.00
|
|
| Hospital Charge Code |
2975057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$893.84 |
| Max. Negotiated Rate |
$1,678.23 |
| Rate for Payer: Aetna Commercial |
$1,641.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.80
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,678.23
|
| Rate for Payer: Health EOS Commercial |
$1,623.50
|
| Rate for Payer: HFN Commercial |
$1,678.23
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.23
|
| Rate for Payer: Quartz Beloit One Network |
$893.84
|
| Rate for Payer: Quartz Commercial |
$1,094.50
|
| Rate for Payer: WEA Trust Commercial |
$1,003.29
|
| Rate for Payer: WPS Commercial |
$1,351.11
|
|
|
NEEDLE SET PED EZ-IO 9018
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2975061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
NEEDLE SET PED EZ-IO 9018
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2975061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
