|
RETRACTOR ALEXIS WOUND MEDIUM C8302
|
Facility
|
IP
|
$1,707.00
|
|
| Hospital Charge Code |
2964644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.43 |
| Max. Negotiated Rate |
$1,570.44 |
| Rate for Payer: Aetna Commercial |
$1,536.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.71
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna Commercial |
$1,570.44
|
| Rate for Payer: Health EOS Commercial |
$1,519.23
|
| Rate for Payer: HFN Commercial |
$1,570.44
|
| Rate for Payer: Multiplan Commercial |
$1,365.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.44
|
| Rate for Payer: Quartz Beloit One Network |
$836.43
|
| Rate for Payer: Quartz Commercial |
$1,024.20
|
| Rate for Payer: WEA Trust Commercial |
$938.85
|
| Rate for Payer: WPS Commercial |
$1,264.37
|
|
|
RETRACTOR ALEXIS WOUND SMALL C8301
|
Facility
|
IP
|
$864.00
|
|
| Hospital Charge Code |
5240655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.36 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$777.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.92
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$794.88
|
| Rate for Payer: Health EOS Commercial |
$768.96
|
| Rate for Payer: HFN Commercial |
$794.88
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: NAPHCARE Commercial |
$518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$794.88
|
| Rate for Payer: Quartz Beloit One Network |
$423.36
|
| Rate for Payer: Quartz Commercial |
$518.40
|
| Rate for Payer: WEA Trust Commercial |
$475.20
|
| Rate for Payer: WPS Commercial |
$639.96
|
|
|
RETRACTOR ALEXIS WOUND SMALL C8301
|
Facility
|
OP
|
$864.00
|
|
| Hospital Charge Code |
5240655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.92 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$777.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.04
|
| Rate for Payer: Aetna Managed Medicare |
$241.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$561.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$432.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$414.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.92
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$794.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$483.49
|
| Rate for Payer: Health EOS Commercial |
$768.96
|
| Rate for Payer: HFN Commercial |
$794.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.00
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: NAPHCARE Commercial |
$518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$794.88
|
| Rate for Payer: Quartz Beloit One Network |
$423.36
|
| Rate for Payer: Quartz Commercial |
$561.60
|
| Rate for Payer: Quartz Medicare Advantage |
$518.40
|
| Rate for Payer: The Alliance Commercial |
$3,456.00
|
| Rate for Payer: WEA Trust Commercial |
$475.20
|
| Rate for Payer: WPS Commercial |
$639.96
|
|
|
RETRACTOR II ENDO FAN 10MM 176647
|
Facility
|
IP
|
$1,695.00
|
|
| Hospital Charge Code |
2965804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$830.55 |
| Max. Negotiated Rate |
$1,559.40 |
| Rate for Payer: Aetna Commercial |
$1,525.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.35
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna Commercial |
$1,559.40
|
| Rate for Payer: Health EOS Commercial |
$1,508.55
|
| Rate for Payer: HFN Commercial |
$1,559.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.40
|
| Rate for Payer: Quartz Beloit One Network |
$830.55
|
| Rate for Payer: Quartz Commercial |
$1,017.00
|
| Rate for Payer: WEA Trust Commercial |
$932.25
|
| Rate for Payer: WPS Commercial |
$1,255.49
|
|
|
RETRACTOR II ENDO FAN 10MM 176647
|
Facility
|
OP
|
$1,695.00
|
|
| Hospital Charge Code |
2965804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.60 |
| Max. Negotiated Rate |
$6,780.00 |
| Rate for Payer: Aetna Commercial |
$1,525.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.70
|
| Rate for Payer: Aetna Managed Medicare |
$474.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.35
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna Commercial |
$1,559.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.52
|
| Rate for Payer: Health EOS Commercial |
$1,508.55
|
| Rate for Payer: HFN Commercial |
$1,559.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.25
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.40
|
| Rate for Payer: Quartz Beloit One Network |
$830.55
|
| Rate for Payer: Quartz Commercial |
$1,101.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.00
|
| Rate for Payer: The Alliance Commercial |
$6,780.00
|
| Rate for Payer: WEA Trust Commercial |
$932.25
|
| Rate for Payer: WPS Commercial |
$1,255.49
|
|
|
RETRACTOR IRIS FLEXIBLE GRIESHABER 611.75
|
Facility
|
IP
|
$1,271.00
|
|
| Hospital Charge Code |
2964178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.79 |
| Max. Negotiated Rate |
$1,169.32 |
| Rate for Payer: Aetna Commercial |
$1,143.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,093.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.63
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cigna Commercial |
$1,169.32
|
| Rate for Payer: Health EOS Commercial |
$1,131.19
|
| Rate for Payer: HFN Commercial |
$1,169.32
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$762.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,169.32
|
| Rate for Payer: Quartz Beloit One Network |
$622.79
|
| Rate for Payer: Quartz Commercial |
$762.60
|
| Rate for Payer: WEA Trust Commercial |
$699.05
|
| Rate for Payer: WPS Commercial |
$941.43
|
|
|
RETRACTOR IRIS FLEXIBLE GRIESHABER 611.75
|
Facility
|
OP
|
$1,271.00
|
|
| Hospital Charge Code |
2964178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.88 |
| Max. Negotiated Rate |
$5,084.00 |
| Rate for Payer: Aetna Commercial |
$1,143.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,093.06
|
| Rate for Payer: Aetna Managed Medicare |
$355.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$826.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$610.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.63
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cigna Commercial |
$1,169.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$711.25
|
| Rate for Payer: Health EOS Commercial |
$1,131.19
|
| Rate for Payer: HFN Commercial |
$1,169.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$953.25
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$762.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,169.32
|
| Rate for Payer: Quartz Beloit One Network |
$622.79
|
| Rate for Payer: Quartz Commercial |
$826.15
|
| Rate for Payer: Quartz Medicare Advantage |
$762.60
|
| Rate for Payer: The Alliance Commercial |
$5,084.00
|
| Rate for Payer: WEA Trust Commercial |
$699.05
|
| Rate for Payer: WPS Commercial |
$941.43
|
|
|
RETRACTOR IRIS TRANSLIMBAL 4.02-2
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2973099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
RETRACTOR IRIS TRANSLIMBAL 4.02-2
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2973099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
RETRACTOR LONE STAR APS 3715
|
Facility
|
IP
|
$1,385.00
|
|
| Hospital Charge Code |
2964992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.65 |
| Max. Negotiated Rate |
$1,274.20 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$831.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
RETRACTOR LONE STAR APS 3715
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
2964992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$5,540.00 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Aetna Managed Medicare |
$387.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$900.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$692.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$664.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.05
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.75
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$900.25
|
| Rate for Payer: Quartz Medicare Advantage |
$831.00
|
| Rate for Payer: The Alliance Commercial |
$5,540.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
RETRACTOR MST CAPSULE MCR-0001-1
|
Facility
|
OP
|
$1,743.00
|
|
| Hospital Charge Code |
4519891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.04 |
| Max. Negotiated Rate |
$6,972.00 |
| Rate for Payer: Aetna Commercial |
$1,568.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,498.98
|
| Rate for Payer: Aetna Managed Medicare |
$488.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,132.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$871.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$836.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.79
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,603.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$975.38
|
| Rate for Payer: Health EOS Commercial |
$1,551.27
|
| Rate for Payer: HFN Commercial |
$1,603.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,307.25
|
| Rate for Payer: Multiplan Commercial |
$1,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.56
|
| Rate for Payer: Quartz Beloit One Network |
$854.07
|
| Rate for Payer: Quartz Commercial |
$1,132.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,045.80
|
| Rate for Payer: The Alliance Commercial |
$6,972.00
|
| Rate for Payer: WEA Trust Commercial |
$958.65
|
| Rate for Payer: WPS Commercial |
$1,291.04
|
|
|
RETRACTOR MST CAPSULE MCR-0001-1
|
Facility
|
IP
|
$1,743.00
|
|
| Hospital Charge Code |
4519891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$854.07 |
| Max. Negotiated Rate |
$1,603.56 |
| Rate for Payer: Aetna Commercial |
$1,568.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,498.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.79
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,603.56
|
| Rate for Payer: Health EOS Commercial |
$1,551.27
|
| Rate for Payer: HFN Commercial |
$1,603.56
|
| Rate for Payer: Multiplan Commercial |
$1,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.56
|
| Rate for Payer: Quartz Beloit One Network |
$854.07
|
| Rate for Payer: Quartz Commercial |
$1,045.80
|
| Rate for Payer: WEA Trust Commercial |
$958.65
|
| Rate for Payer: WPS Commercial |
$1,291.04
|
|
|
RETRACTOR SYSTEM DEEP SCROTAL 72403867
|
Facility
|
IP
|
$4,733.00
|
|
| Hospital Charge Code |
5349210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,319.17 |
| Max. Negotiated Rate |
$4,354.36 |
| Rate for Payer: Aetna Commercial |
$4,259.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,070.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,508.49
|
| Rate for Payer: Cash Price |
$1,419.90
|
| Rate for Payer: Cigna Commercial |
$4,354.36
|
| Rate for Payer: Health EOS Commercial |
$4,212.37
|
| Rate for Payer: HFN Commercial |
$4,354.36
|
| Rate for Payer: Multiplan Commercial |
$3,786.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,839.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,354.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,319.17
|
| Rate for Payer: Quartz Commercial |
$2,839.80
|
| Rate for Payer: WEA Trust Commercial |
$2,603.15
|
| Rate for Payer: WPS Commercial |
$3,505.73
|
|
|
RETRACTOR SYSTEM DEEP SCROTAL 72403867
|
Facility
|
OP
|
$4,733.00
|
|
| Hospital Charge Code |
5349210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.24 |
| Max. Negotiated Rate |
$18,932.00 |
| Rate for Payer: Aetna Commercial |
$4,259.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,070.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,325.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,076.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,366.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,271.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,508.49
|
| Rate for Payer: Cash Price |
$1,419.90
|
| Rate for Payer: Cigna Commercial |
$4,354.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,648.59
|
| Rate for Payer: Health EOS Commercial |
$4,212.37
|
| Rate for Payer: HFN Commercial |
$4,354.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,549.75
|
| Rate for Payer: Multiplan Commercial |
$3,786.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,839.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,354.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,319.17
|
| Rate for Payer: Quartz Commercial |
$3,076.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,839.80
|
| Rate for Payer: The Alliance Commercial |
$18,932.00
|
| Rate for Payer: WEA Trust Commercial |
$2,603.15
|
| Rate for Payer: WPS Commercial |
$3,505.73
|
|
|
RETRIEVAL BAG APPLIED 5MM CD003
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5179327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
RETRIEVAL BAG APPLIED 5MM CD003
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5179327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
RETRIEVAL COIL STONE CONE 3FR 10MM M0063903200
|
Facility
|
OP
|
$2,862.00
|
|
| Hospital Charge Code |
4520074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$801.36 |
| Max. Negotiated Rate |
$11,448.00 |
| Rate for Payer: Aetna Commercial |
$2,575.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.32
|
| Rate for Payer: Aetna Managed Medicare |
$801.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.86
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,633.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.58
|
| Rate for Payer: Health EOS Commercial |
$2,547.18
|
| Rate for Payer: HFN Commercial |
$2,633.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.50
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.38
|
| Rate for Payer: Quartz Commercial |
$1,860.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.20
|
| Rate for Payer: The Alliance Commercial |
$11,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,574.10
|
| Rate for Payer: WPS Commercial |
$2,119.88
|
|
|
RETRIEVAL COIL STONE CONE 3FR 10MM M0063903200
|
Facility
|
IP
|
$2,862.00
|
|
| Hospital Charge Code |
4520074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.38 |
| Max. Negotiated Rate |
$2,633.04 |
| Rate for Payer: Aetna Commercial |
$2,575.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.86
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,633.04
|
| Rate for Payer: Health EOS Commercial |
$2,547.18
|
| Rate for Payer: HFN Commercial |
$2,633.04
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.38
|
| Rate for Payer: Quartz Commercial |
$1,717.20
|
| Rate for Payer: WEA Trust Commercial |
$1,574.10
|
| Rate for Payer: WPS Commercial |
$2,119.88
|
|
|
RETRIEVAL COIL STONE CONE 3FR 7MM M0063903100
|
Facility
|
OP
|
$2,972.00
|
|
| Hospital Charge Code |
4998725
|
|
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
|
|
|
RETRIEVAL COIL STONE CONE 3FR 7MM M0063903100
|
Facility
|
IP
|
$2,972.00
|
|
| Hospital Charge Code |
4998725
|
|
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
|
|
|
RETRIEVAL DEVICE SPIDER NET 0230AM
|
Facility
|
OP
|
$1,141.00
|
|
| Hospital Charge Code |
4998731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$4,564.00 |
| Rate for Payer: Aetna Commercial |
$1,026.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.26
|
| Rate for Payer: Aetna Managed Medicare |
$319.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$741.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$570.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$547.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.73
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,049.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$638.50
|
| Rate for Payer: Health EOS Commercial |
$1,015.49
|
| Rate for Payer: HFN Commercial |
$1,049.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.75
|
| Rate for Payer: Multiplan Commercial |
$912.80
|
| Rate for Payer: NAPHCARE Commercial |
$684.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.72
|
| Rate for Payer: Quartz Beloit One Network |
$559.09
|
| Rate for Payer: Quartz Commercial |
$741.65
|
| Rate for Payer: Quartz Medicare Advantage |
$684.60
|
| Rate for Payer: The Alliance Commercial |
$4,564.00
|
| Rate for Payer: WEA Trust Commercial |
$627.55
|
| Rate for Payer: WPS Commercial |
$845.14
|
|
|
RETRIEVAL DEVICE SPIDER NET 0230AM
|
Facility
|
IP
|
$1,141.00
|
|
| Hospital Charge Code |
4998731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.09 |
| Max. Negotiated Rate |
$1,049.72 |
| Rate for Payer: Aetna Commercial |
$1,026.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.73
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,049.72
|
| Rate for Payer: Health EOS Commercial |
$1,015.49
|
| Rate for Payer: HFN Commercial |
$1,049.72
|
| Rate for Payer: Multiplan Commercial |
$912.80
|
| Rate for Payer: NAPHCARE Commercial |
$684.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.72
|
| Rate for Payer: Quartz Beloit One Network |
$559.09
|
| Rate for Payer: Quartz Commercial |
$684.60
|
| Rate for Payer: WEA Trust Commercial |
$627.55
|
| Rate for Payer: WPS Commercial |
$845.14
|
|
|
RETRIEVAL FORCEP 3.3FR X 115CM 210320 G14922
|
Facility
|
IP
|
$2,919.00
|
|
| Hospital Charge Code |
6210967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,430.31 |
| Max. Negotiated Rate |
$2,685.48 |
| Rate for Payer: Aetna Commercial |
$2,627.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,510.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.07
|
| Rate for Payer: Cash Price |
$875.70
|
| Rate for Payer: Cigna Commercial |
$2,685.48
|
| Rate for Payer: Health EOS Commercial |
$2,597.91
|
| Rate for Payer: HFN Commercial |
$2,685.48
|
| Rate for Payer: Multiplan Commercial |
$2,335.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,751.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,685.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.31
|
| Rate for Payer: Quartz Commercial |
$1,751.40
|
| Rate for Payer: WEA Trust Commercial |
$1,605.45
|
| Rate for Payer: WPS Commercial |
$2,162.10
|
|
|
RETRIEVAL FORCEP 3.3FR X 115CM 210320 G14922
|
Facility
|
OP
|
$2,919.00
|
|
| Hospital Charge Code |
6210967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.32 |
| Max. Negotiated Rate |
$11,676.00 |
| Rate for Payer: Aetna Commercial |
$2,627.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,510.34
|
| Rate for Payer: Aetna Managed Medicare |
$817.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,897.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,459.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,401.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.07
|
| Rate for Payer: Cash Price |
$875.70
|
| Rate for Payer: Cigna Commercial |
$2,685.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,633.47
|
| Rate for Payer: Health EOS Commercial |
$2,597.91
|
| Rate for Payer: HFN Commercial |
$2,685.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,189.25
|
| Rate for Payer: Multiplan Commercial |
$2,335.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,751.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,685.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.31
|
| Rate for Payer: Quartz Commercial |
$1,897.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,751.40
|
| Rate for Payer: The Alliance Commercial |
$11,676.00
|
| Rate for Payer: WEA Trust Commercial |
$1,605.45
|
| Rate for Payer: WPS Commercial |
$2,162.10
|
|
