|
RETRACTOR ALEXIS WOUND SMALL C8301
|
Facility
|
OP
|
$864.00
|
|
| Hospital Charge Code |
5240655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$826.68 |
| Rate for Payer: Aetna Commercial |
$808.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$251.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$584.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$449.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$431.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$826.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.85
|
| Rate for Payer: Health EOS Commercial |
$799.72
|
| Rate for Payer: HFN Commercial |
$826.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.92
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$539.14
|
| Rate for Payer: Preferred Network Access Commercial |
$826.68
|
| Rate for Payer: Quartz Beloit One Network |
$440.29
|
| Rate for Payer: Quartz Commercial |
$584.06
|
| Rate for Payer: Quartz Medicare Advantage |
$539.14
|
| Rate for Payer: The Alliance Commercial |
$449.28
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$665.54
|
|
|
RETRACTOR II ENDO FAN 10MM 176647
|
Facility
|
OP
|
$1,695.00
|
|
| Hospital Charge Code |
2965804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.58 |
| Max. Negotiated Rate |
$1,621.78 |
| Rate for Payer: Aetna Commercial |
$1,586.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.01
|
| Rate for Payer: Aetna Managed Medicare |
$493.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,145.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$881.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$846.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.28
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna Commercial |
$1,621.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$986.49
|
| Rate for Payer: Health EOS Commercial |
$1,568.89
|
| Rate for Payer: HFN Commercial |
$1,621.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.10
|
| Rate for Payer: Multiplan Commercial |
$1,410.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.78
|
| Rate for Payer: Quartz Beloit One Network |
$863.77
|
| Rate for Payer: Quartz Commercial |
$1,145.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.68
|
| Rate for Payer: The Alliance Commercial |
$881.40
|
| Rate for Payer: WEA Trust Commercial |
$969.54
|
| Rate for Payer: WPS Commercial |
$1,305.66
|
|
|
RETRACTOR II ENDO FAN 10MM 176647
|
Facility
|
IP
|
$1,695.00
|
|
| Hospital Charge Code |
2965804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$863.77 |
| Max. Negotiated Rate |
$1,621.78 |
| Rate for Payer: Aetna Commercial |
$1,586.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.28
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna Commercial |
$1,621.78
|
| Rate for Payer: Health EOS Commercial |
$1,568.89
|
| Rate for Payer: HFN Commercial |
$1,621.78
|
| Rate for Payer: Multiplan Commercial |
$1,410.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.78
|
| Rate for Payer: Quartz Beloit One Network |
$863.77
|
| Rate for Payer: Quartz Commercial |
$1,057.68
|
| Rate for Payer: WEA Trust Commercial |
$969.54
|
| Rate for Payer: WPS Commercial |
$1,305.66
|
|
|
RETRACTOR IRIS FLEXIBLE GRIESHABER 611.75
|
Facility
|
IP
|
$1,271.00
|
|
| Hospital Charge Code |
2964178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.70 |
| Max. Negotiated Rate |
$1,216.09 |
| Rate for Payer: Aetna Commercial |
$1,189.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.58
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cigna Commercial |
$1,216.09
|
| Rate for Payer: Health EOS Commercial |
$1,176.44
|
| Rate for Payer: HFN Commercial |
$1,216.09
|
| Rate for Payer: Multiplan Commercial |
$1,057.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.09
|
| Rate for Payer: Quartz Beloit One Network |
$647.70
|
| Rate for Payer: Quartz Commercial |
$793.10
|
| Rate for Payer: WEA Trust Commercial |
$727.01
|
| Rate for Payer: WPS Commercial |
$979.05
|
|
|
RETRACTOR IRIS FLEXIBLE GRIESHABER 611.75
|
Facility
|
OP
|
$1,271.00
|
|
| Hospital Charge Code |
2964178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.12 |
| Max. Negotiated Rate |
$1,216.09 |
| Rate for Payer: Aetna Commercial |
$1,189.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.78
|
| Rate for Payer: Aetna Managed Medicare |
$370.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.58
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cigna Commercial |
$1,216.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.72
|
| Rate for Payer: Health EOS Commercial |
$1,176.44
|
| Rate for Payer: HFN Commercial |
$1,216.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.38
|
| Rate for Payer: Multiplan Commercial |
$1,057.47
|
| Rate for Payer: NAPHCARE Commercial |
$793.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.09
|
| Rate for Payer: Quartz Beloit One Network |
$647.70
|
| Rate for Payer: Quartz Commercial |
$859.20
|
| Rate for Payer: Quartz Medicare Advantage |
$793.10
|
| Rate for Payer: The Alliance Commercial |
$660.92
|
| Rate for Payer: WEA Trust Commercial |
$727.01
|
| Rate for Payer: WPS Commercial |
$979.05
|
|
|
RETRACTOR IRIS TRANSLIMBAL 4.02-2
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2973099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
RETRACTOR IRIS TRANSLIMBAL 4.02-2
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2973099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
RETRACTOR LONE STAR APS 3715
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
2964992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.31 |
| Max. Negotiated Rate |
$1,325.17 |
| Rate for Payer: Aetna Commercial |
$1,296.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.74
|
| Rate for Payer: Aetna Managed Medicare |
$403.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$936.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$720.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.41
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,325.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$806.07
|
| Rate for Payer: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,080.30
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: NAPHCARE Commercial |
$864.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$936.26
|
| Rate for Payer: Quartz Medicare Advantage |
$864.24
|
| Rate for Payer: The Alliance Commercial |
$720.20
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
|
RETRACTOR LONE STAR APS 3715
|
Facility
|
IP
|
$1,385.00
|
|
| Hospital Charge Code |
2964992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.80 |
| Max. Negotiated Rate |
$1,325.17 |
| Rate for Payer: Aetna Commercial |
$1,296.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.41
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,325.17
|
| Rate for Payer: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$864.24
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
|
RETRACTOR MST CAPSULE MCR-0001-1
|
Facility
|
OP
|
$1,743.00
|
|
| Hospital Charge Code |
4519891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.56 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Aetna Managed Medicare |
$507.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,178.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$870.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.43
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.54
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,178.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.63
|
| Rate for Payer: The Alliance Commercial |
$906.36
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
RETRACTOR MST CAPSULE MCR-0001-1
|
Facility
|
IP
|
$1,743.00
|
|
| Hospital Charge Code |
4519891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.23 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,087.63
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
RETRACTOR SYSTEM DEEP SCROTAL 72403867
|
Facility
|
IP
|
$4,733.00
|
|
| Hospital Charge Code |
5349210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,411.94 |
| Max. Negotiated Rate |
$4,528.53 |
| Rate for Payer: Aetna Commercial |
$4,430.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.83
|
| Rate for Payer: Cash Price |
$1,419.90
|
| Rate for Payer: Cigna Commercial |
$4,528.53
|
| Rate for Payer: Health EOS Commercial |
$4,380.86
|
| Rate for Payer: HFN Commercial |
$4,528.53
|
| Rate for Payer: Multiplan Commercial |
$3,937.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,528.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.94
|
| Rate for Payer: Quartz Commercial |
$2,953.39
|
| Rate for Payer: WEA Trust Commercial |
$2,707.28
|
| Rate for Payer: WPS Commercial |
$3,645.83
|
|
|
RETRACTOR SYSTEM DEEP SCROTAL 72403867
|
Facility
|
OP
|
$4,733.00
|
|
| Hospital Charge Code |
5349210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,378.25 |
| Max. Negotiated Rate |
$4,528.53 |
| Rate for Payer: Aetna Commercial |
$4,430.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,362.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.83
|
| Rate for Payer: Cash Price |
$1,419.90
|
| Rate for Payer: Cigna Commercial |
$4,528.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.61
|
| Rate for Payer: Health EOS Commercial |
$4,380.86
|
| Rate for Payer: HFN Commercial |
$4,528.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,691.74
|
| Rate for Payer: Multiplan Commercial |
$3,937.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.39
|
| Rate for Payer: Preferred Network Access Commercial |
$4,528.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.94
|
| Rate for Payer: Quartz Commercial |
$3,199.51
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.39
|
| Rate for Payer: The Alliance Commercial |
$2,461.16
|
| Rate for Payer: WEA Trust Commercial |
$2,707.28
|
| Rate for Payer: WPS Commercial |
$3,645.83
|
|
|
RETRIEVAL BAG APPLIED 5MM CD003
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5179327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
RETRIEVAL BAG APPLIED 5MM CD003
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5179327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
RETRIEVAL COIL STONE CONE 3FR 10MM M0063903200
|
Facility
|
IP
|
$2,862.00
|
|
| Hospital Charge Code |
4520074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,458.48 |
| Max. Negotiated Rate |
$2,738.36 |
| Rate for Payer: Aetna Commercial |
$2,678.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,559.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,577.53
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,738.36
|
| Rate for Payer: Health EOS Commercial |
$2,649.07
|
| Rate for Payer: HFN Commercial |
$2,738.36
|
| Rate for Payer: Multiplan Commercial |
$2,381.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,738.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,458.48
|
| Rate for Payer: Quartz Commercial |
$1,785.89
|
| Rate for Payer: WEA Trust Commercial |
$1,637.06
|
| Rate for Payer: WPS Commercial |
$2,204.60
|
|
|
RETRIEVAL COIL STONE CONE 3FR 10MM M0063903200
|
Facility
|
OP
|
$2,862.00
|
|
| Hospital Charge Code |
4520074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$833.41 |
| Max. Negotiated Rate |
$2,738.36 |
| Rate for Payer: Aetna Commercial |
$2,678.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,559.77
|
| Rate for Payer: Aetna Managed Medicare |
$833.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,934.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,488.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,428.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,577.53
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,738.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.68
|
| Rate for Payer: Health EOS Commercial |
$2,649.07
|
| Rate for Payer: HFN Commercial |
$2,738.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,232.36
|
| Rate for Payer: Multiplan Commercial |
$2,381.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,785.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,738.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,458.48
|
| Rate for Payer: Quartz Commercial |
$1,934.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,785.89
|
| Rate for Payer: The Alliance Commercial |
$1,488.24
|
| Rate for Payer: WEA Trust Commercial |
$1,637.06
|
| Rate for Payer: WPS Commercial |
$2,204.60
|
|
|
RETRIEVAL COIL STONE CONE 3FR 7MM M0063903100
|
Facility
|
IP
|
$2,972.00
|
|
| Hospital Charge Code |
4998725
|
|
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
|
|
|
RETRIEVAL COIL STONE CONE 3FR 7MM M0063903100
|
Facility
|
OP
|
$2,972.00
|
|
| Hospital Charge Code |
4998725
|
|
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
|
|
|
RETRIEVAL DEVICE SPIDER NET 0230AM
|
Facility
|
OP
|
$1,141.00
|
|
| Hospital Charge Code |
4998731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$1,091.71 |
| Rate for Payer: Aetna Commercial |
$1,067.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.51
|
| Rate for Payer: Aetna Managed Medicare |
$332.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$771.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$593.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$569.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.92
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,091.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.06
|
| Rate for Payer: Health EOS Commercial |
$1,056.11
|
| Rate for Payer: HFN Commercial |
$1,091.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$889.98
|
| Rate for Payer: Multiplan Commercial |
$949.31
|
| Rate for Payer: NAPHCARE Commercial |
$711.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,091.71
|
| Rate for Payer: Quartz Beloit One Network |
$581.45
|
| Rate for Payer: Quartz Commercial |
$771.32
|
| Rate for Payer: Quartz Medicare Advantage |
$711.98
|
| Rate for Payer: The Alliance Commercial |
$593.32
|
| Rate for Payer: WEA Trust Commercial |
$652.65
|
| Rate for Payer: WPS Commercial |
$878.91
|
|
|
RETRIEVAL DEVICE SPIDER NET 0230AM
|
Facility
|
IP
|
$1,141.00
|
|
| Hospital Charge Code |
4998731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.45 |
| Max. Negotiated Rate |
$1,091.71 |
| Rate for Payer: Aetna Commercial |
$1,067.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.92
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,091.71
|
| Rate for Payer: Health EOS Commercial |
$1,056.11
|
| Rate for Payer: HFN Commercial |
$1,091.71
|
| Rate for Payer: Multiplan Commercial |
$949.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,091.71
|
| Rate for Payer: Quartz Beloit One Network |
$581.45
|
| Rate for Payer: Quartz Commercial |
$711.98
|
| Rate for Payer: WEA Trust Commercial |
$652.65
|
| Rate for Payer: WPS Commercial |
$878.91
|
|
|
RETRIEVAL FORCEP 3.3FR X 115CM 210320 G14922
|
Facility
|
OP
|
$2,919.00
|
|
| Hospital Charge Code |
6210967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.01 |
| Max. Negotiated Rate |
$2,792.90 |
| Rate for Payer: Aetna Commercial |
$2,732.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,610.75
|
| Rate for Payer: Aetna Managed Medicare |
$850.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,973.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,517.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,457.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,608.95
|
| Rate for Payer: Cash Price |
$875.70
|
| Rate for Payer: Cigna Commercial |
$2,792.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,698.86
|
| Rate for Payer: Health EOS Commercial |
$2,701.83
|
| Rate for Payer: HFN Commercial |
$2,792.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,276.82
|
| Rate for Payer: Multiplan Commercial |
$2,428.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,821.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,792.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,487.52
|
| Rate for Payer: Quartz Commercial |
$1,973.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,821.46
|
| Rate for Payer: The Alliance Commercial |
$1,517.88
|
| Rate for Payer: WEA Trust Commercial |
$1,669.67
|
| Rate for Payer: WPS Commercial |
$2,248.51
|
|
|
RETRIEVAL FORCEP 3.3FR X 115CM 210320 G14922
|
Facility
|
IP
|
$2,919.00
|
|
| Hospital Charge Code |
6210967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,487.52 |
| Max. Negotiated Rate |
$2,792.90 |
| Rate for Payer: Aetna Commercial |
$2,732.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,610.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,608.95
|
| Rate for Payer: Cash Price |
$875.70
|
| Rate for Payer: Cigna Commercial |
$2,792.90
|
| Rate for Payer: Health EOS Commercial |
$2,701.83
|
| Rate for Payer: HFN Commercial |
$2,792.90
|
| Rate for Payer: Multiplan Commercial |
$2,428.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,792.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,487.52
|
| Rate for Payer: Quartz Commercial |
$1,821.46
|
| Rate for Payer: WEA Trust Commercial |
$1,669.67
|
| Rate for Payer: WPS Commercial |
$2,248.51
|
|
|
RETRIEVAL NET DISPOSABLE 711052
|
Facility
|
IP
|
$1,418.00
|
|
| Hospital Charge Code |
2973731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$722.61 |
| Max. Negotiated Rate |
$1,356.74 |
| Rate for Payer: Aetna Commercial |
$1,327.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,268.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$781.60
|
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$1,356.74
|
| Rate for Payer: Health EOS Commercial |
$1,312.50
|
| Rate for Payer: HFN Commercial |
$1,356.74
|
| Rate for Payer: Multiplan Commercial |
$1,179.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,356.74
|
| Rate for Payer: Quartz Beloit One Network |
$722.61
|
| Rate for Payer: Quartz Commercial |
$884.83
|
| Rate for Payer: WEA Trust Commercial |
$811.10
|
| Rate for Payer: WPS Commercial |
$1,092.29
|
|
|
RETRIEVAL NET DISPOSABLE 711052
|
Facility
|
OP
|
$1,418.00
|
|
| Hospital Charge Code |
2973731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.92 |
| Max. Negotiated Rate |
$1,356.74 |
| Rate for Payer: Aetna Commercial |
$1,327.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,268.26
|
| Rate for Payer: Aetna Managed Medicare |
$412.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$958.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$737.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$707.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$781.60
|
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$1,356.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$825.28
|
| Rate for Payer: Health EOS Commercial |
$1,312.50
|
| Rate for Payer: HFN Commercial |
$1,356.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,106.04
|
| Rate for Payer: Multiplan Commercial |
$1,179.78
|
| Rate for Payer: NAPHCARE Commercial |
$884.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,356.74
|
| Rate for Payer: Quartz Beloit One Network |
$722.61
|
| Rate for Payer: Quartz Commercial |
$958.57
|
| Rate for Payer: Quartz Medicare Advantage |
$884.83
|
| Rate for Payer: The Alliance Commercial |
$737.36
|
| Rate for Payer: WEA Trust Commercial |
$811.10
|
| Rate for Payer: WPS Commercial |
$1,092.29
|
|
