|
TROCAR 3.2MM 71751136
|
Facility
IP
|
$1,823.00
|
|
| Hospital Charge Code |
2966056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$893.27 |
| Max. Negotiated Rate |
$1,677.16 |
| Rate for Payer: Aetna Commercial |
$1,640.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.19
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,677.16
|
| Rate for Payer: Health EOS Commercial |
$1,622.47
|
| Rate for Payer: HFN Commercial |
$1,677.16
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,093.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.16
|
| Rate for Payer: Quartz Beloit One Network |
$893.27
|
| Rate for Payer: Quartz Commercial |
$1,093.80
|
| Rate for Payer: WEA Trust Commercial |
$1,002.65
|
| Rate for Payer: WPS Commercial |
$1,350.30
|
|
|
TROCAR 5MM APPLE #900-800
|
Facility
IP
|
$672.00
|
|
| Hospital Charge Code |
2963108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.28 |
| Max. Negotiated Rate |
$618.24 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.16
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$618.24
|
| Rate for Payer: Health EOS Commercial |
$598.08
|
| Rate for Payer: HFN Commercial |
$618.24
|
| Rate for Payer: Multiplan Commercial |
$537.60
|
| Rate for Payer: NAPHCARE Commercial |
$403.20
|
| Rate for Payer: Preferred Network Access Commercial |
$618.24
|
| Rate for Payer: Quartz Beloit One Network |
$329.28
|
| Rate for Payer: Quartz Commercial |
$403.20
|
| Rate for Payer: WEA Trust Commercial |
$369.60
|
| Rate for Payer: WPS Commercial |
$497.75
|
|
|
TROCAR 5MM APPLE #900-800
|
Facility
OP
|
$672.00
|
|
| Hospital Charge Code |
2963108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.92
|
| Rate for Payer: Aetna Managed Medicare |
$188.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.16
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$618.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.05
|
| Rate for Payer: Health EOS Commercial |
$598.08
|
| Rate for Payer: HFN Commercial |
$618.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$537.60
|
| Rate for Payer: NAPHCARE Commercial |
$403.20
|
| Rate for Payer: Preferred Network Access Commercial |
$618.24
|
| Rate for Payer: Quartz Beloit One Network |
$329.28
|
| Rate for Payer: Quartz Commercial |
$436.80
|
| Rate for Payer: Quartz Medicare Advantage |
$403.20
|
| Rate for Payer: The Alliance Commercial |
$2,688.00
|
| Rate for Payer: WEA Trust Commercial |
$369.60
|
| Rate for Payer: WPS Commercial |
$497.75
|
|
|
TROCAR 5 X 150MM
|
Facility
IP
|
$414.00
|
|
| Hospital Charge Code |
3153467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
TROCAR 5 X 150MM
|
Facility
OP
|
$414.00
|
|
| Hospital Charge Code |
3153467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
TROCAR 8X100MM WITH STABILITY SLEEVE B8LT
|
Facility
IP
|
$2,284.00
|
|
| Hospital Charge Code |
4520302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.16 |
| Max. Negotiated Rate |
$2,101.28 |
| Rate for Payer: Aetna Commercial |
$2,055.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.52
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cigna Commercial |
$2,101.28
|
| Rate for Payer: Health EOS Commercial |
$2,032.76
|
| Rate for Payer: HFN Commercial |
$2,101.28
|
| Rate for Payer: Multiplan Commercial |
$1,827.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,370.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.16
|
| Rate for Payer: Quartz Commercial |
$1,370.40
|
| Rate for Payer: WEA Trust Commercial |
$1,256.20
|
| Rate for Payer: WPS Commercial |
$1,691.76
|
|
|
TROCAR 8X100MM WITH STABILITY SLEEVE B8LT
|
Facility
OP
|
$2,284.00
|
|
| Hospital Charge Code |
4520302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.52 |
| Max. Negotiated Rate |
$9,136.00 |
| Rate for Payer: Aetna Commercial |
$2,055.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.24
|
| Rate for Payer: Aetna Managed Medicare |
$639.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,484.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,142.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,096.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.52
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cigna Commercial |
$2,101.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.13
|
| Rate for Payer: Health EOS Commercial |
$2,032.76
|
| Rate for Payer: HFN Commercial |
$2,101.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,713.00
|
| Rate for Payer: Multiplan Commercial |
$1,827.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,370.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.16
|
| Rate for Payer: Quartz Commercial |
$1,484.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,370.40
|
| Rate for Payer: The Alliance Commercial |
$9,136.00
|
| Rate for Payer: WEA Trust Commercial |
$1,256.20
|
| Rate for Payer: WPS Commercial |
$1,691.76
|
|
|
TROCAR BALLOON BLUNT TIP 12 X 130MM C0R50
|
Facility
IP
|
$556.00
|
|
| Hospital Charge Code |
2975050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
TROCAR BALLOON BLUNT TIP 12 X 130MM C0R50
|
Facility
OP
|
$556.00
|
|
| Hospital Charge Code |
2975050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
TROCAR BLADED 12X150MM CFB71
|
Facility
IP
|
$1,097.00
|
|
| Hospital Charge Code |
2963090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.53 |
| Max. Negotiated Rate |
$1,009.24 |
| Rate for Payer: Aetna Commercial |
$987.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.41
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,009.24
|
| Rate for Payer: Health EOS Commercial |
$976.33
|
| Rate for Payer: HFN Commercial |
$1,009.24
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: NAPHCARE Commercial |
$658.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.24
|
| Rate for Payer: Quartz Beloit One Network |
$537.53
|
| Rate for Payer: Quartz Commercial |
$658.20
|
| Rate for Payer: WEA Trust Commercial |
$603.35
|
| Rate for Payer: WPS Commercial |
$812.55
|
|
|
TROCAR BLADED 12X150MM CFB71
|
Facility
OP
|
$1,097.00
|
|
| Hospital Charge Code |
2963090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.16 |
| Max. Negotiated Rate |
$4,388.00 |
| Rate for Payer: Aetna Commercial |
$987.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$943.42
|
| Rate for Payer: Aetna Managed Medicare |
$307.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$713.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$526.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.41
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,009.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$613.88
|
| Rate for Payer: Health EOS Commercial |
$976.33
|
| Rate for Payer: HFN Commercial |
$1,009.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$822.75
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: NAPHCARE Commercial |
$658.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.24
|
| Rate for Payer: Quartz Beloit One Network |
$537.53
|
| Rate for Payer: Quartz Commercial |
$713.05
|
| Rate for Payer: Quartz Medicare Advantage |
$658.20
|
| Rate for Payer: The Alliance Commercial |
$4,388.00
|
| Rate for Payer: WEA Trust Commercial |
$603.35
|
| Rate for Payer: WPS Commercial |
$812.55
|
|
|
TROCAR BLADED 5X100MM CFB03
|
Facility
OP
|
$456.00
|
|
| Hospital Charge Code |
3092814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.16
|
| Rate for Payer: Aetna Managed Medicare |
$127.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$419.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.18
|
| Rate for Payer: Health EOS Commercial |
$405.84
|
| Rate for Payer: HFN Commercial |
$419.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: NAPHCARE Commercial |
$273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.52
|
| Rate for Payer: Quartz Beloit One Network |
$223.44
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: Quartz Medicare Advantage |
$273.60
|
| Rate for Payer: The Alliance Commercial |
$1,824.00
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
TROCAR BLADED 5X100MM CFB03
|
Facility
IP
|
$456.00
|
|
| Hospital Charge Code |
3092814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$419.52
|
| Rate for Payer: Health EOS Commercial |
$405.84
|
| Rate for Payer: HFN Commercial |
$419.52
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: NAPHCARE Commercial |
$273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.52
|
| Rate for Payer: Quartz Beloit One Network |
$223.44
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
TROCAR BLADED KII 5X100MM CTB03
|
Facility
IP
|
$1,171.00
|
|
| Hospital Charge Code |
2962991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$573.79 |
| Max. Negotiated Rate |
$1,077.32 |
| Rate for Payer: Aetna Commercial |
$1,053.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$620.63
|
| Rate for Payer: Cash Price |
$351.30
|
| Rate for Payer: Cigna Commercial |
$1,077.32
|
| Rate for Payer: Health EOS Commercial |
$1,042.19
|
| Rate for Payer: HFN Commercial |
$1,077.32
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: NAPHCARE Commercial |
$702.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,077.32
|
| Rate for Payer: Quartz Beloit One Network |
$573.79
|
| Rate for Payer: Quartz Commercial |
$702.60
|
| Rate for Payer: WEA Trust Commercial |
$644.05
|
| Rate for Payer: WPS Commercial |
$867.36
|
|
|
TROCAR BLADED KII 5X100MM CTB03
|
Facility
OP
|
$1,171.00
|
|
| Hospital Charge Code |
2962991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.88 |
| Max. Negotiated Rate |
$4,684.00 |
| Rate for Payer: Aetna Commercial |
$1,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.06
|
| Rate for Payer: Aetna Managed Medicare |
$327.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$761.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$562.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$620.63
|
| Rate for Payer: Cash Price |
$351.30
|
| Rate for Payer: Cigna Commercial |
$1,077.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$655.29
|
| Rate for Payer: Health EOS Commercial |
$1,042.19
|
| Rate for Payer: HFN Commercial |
$1,077.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$878.25
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: NAPHCARE Commercial |
$702.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,077.32
|
| Rate for Payer: Quartz Beloit One Network |
$573.79
|
| Rate for Payer: Quartz Commercial |
$761.15
|
| Rate for Payer: Quartz Medicare Advantage |
$702.60
|
| Rate for Payer: The Alliance Commercial |
$4,684.00
|
| Rate for Payer: WEA Trust Commercial |
$644.05
|
| Rate for Payer: WPS Commercial |
$867.36
|
|
|
TROCAR KII BALLOON 12X100MM COR47
|
Facility
IP
|
$1,494.00
|
|
| Hospital Charge Code |
2963107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.06 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$896.40
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
TROCAR KII BALLOON 12X100MM COR47
|
Facility
OP
|
$1,494.00
|
|
| Hospital Charge Code |
2963107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.32 |
| Max. Negotiated Rate |
$5,976.00 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Aetna Managed Medicare |
$418.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$971.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$836.04
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.50
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$971.10
|
| Rate for Payer: Quartz Medicare Advantage |
$896.40
|
| Rate for Payer: The Alliance Commercial |
$5,976.00
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
TROCAR KII BALLOON 12X150MM CFF71
|
Facility
OP
|
$575.00
|
|
| Hospital Charge Code |
5384671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Aetna Managed Medicare |
$161.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.77
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$373.75
|
| Rate for Payer: Quartz Medicare Advantage |
$345.00
|
| Rate for Payer: The Alliance Commercial |
$2,300.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
TROCAR KII BALLOON 12X150MM CFF71
|
Facility
IP
|
$575.00
|
|
| Hospital Charge Code |
5384671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$345.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
TROCAR KII BALLOON 5X150MM CFF01
|
Facility
OP
|
$439.00
|
|
| Hospital Charge Code |
5384672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.66
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.25
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$285.35
|
| Rate for Payer: Quartz Medicare Advantage |
$263.40
|
| Rate for Payer: The Alliance Commercial |
$1,756.00
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR KII BALLOON 5X150MM CFF01
|
Facility
IP
|
$439.00
|
|
| Hospital Charge Code |
5384672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.11 |
| Max. Negotiated Rate |
$403.88 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$263.40
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR KII BLADED 12X100MM CTB73
|
Facility
OP
|
$1,214.00
|
|
| Hospital Charge Code |
2963089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.92 |
| Max. Negotiated Rate |
$4,856.00 |
| Rate for Payer: Aetna Commercial |
$1,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,044.04
|
| Rate for Payer: Aetna Managed Medicare |
$339.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$789.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$607.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$582.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.42
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,116.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.35
|
| Rate for Payer: Health EOS Commercial |
$1,080.46
|
| Rate for Payer: HFN Commercial |
$1,116.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$910.50
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: NAPHCARE Commercial |
$728.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,116.88
|
| Rate for Payer: Quartz Beloit One Network |
$594.86
|
| Rate for Payer: Quartz Commercial |
$789.10
|
| Rate for Payer: Quartz Medicare Advantage |
$728.40
|
| Rate for Payer: The Alliance Commercial |
$4,856.00
|
| Rate for Payer: WEA Trust Commercial |
$667.70
|
| Rate for Payer: WPS Commercial |
$899.21
|
|
|
TROCAR KII BLADED 12X100MM CTB73
|
Facility
IP
|
$1,214.00
|
|
| Hospital Charge Code |
2963089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.86 |
| Max. Negotiated Rate |
$1,116.88 |
| Rate for Payer: Aetna Commercial |
$1,092.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.42
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,116.88
|
| Rate for Payer: Health EOS Commercial |
$1,080.46
|
| Rate for Payer: HFN Commercial |
$1,116.88
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: NAPHCARE Commercial |
$728.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,116.88
|
| Rate for Payer: Quartz Beloit One Network |
$594.86
|
| Rate for Payer: Quartz Commercial |
$728.40
|
| Rate for Payer: WEA Trust Commercial |
$667.70
|
| Rate for Payer: WPS Commercial |
$899.21
|
|
|
TROCAR NON-BLADED 12X100MM Z-THREAD CTF73
|
Facility
OP
|
$597.00
|
|
| Hospital Charge Code |
5179400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$2,388.00 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.42
|
| Rate for Payer: Aetna Managed Medicare |
$167.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$549.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.08
|
| Rate for Payer: Health EOS Commercial |
$531.33
|
| Rate for Payer: HFN Commercial |
$549.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.75
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: NAPHCARE Commercial |
$358.20
|
| Rate for Payer: Preferred Network Access Commercial |
$549.24
|
| Rate for Payer: Quartz Beloit One Network |
$292.53
|
| Rate for Payer: Quartz Commercial |
$388.05
|
| Rate for Payer: Quartz Medicare Advantage |
$358.20
|
| Rate for Payer: The Alliance Commercial |
$2,388.00
|
| Rate for Payer: WEA Trust Commercial |
$328.35
|
| Rate for Payer: WPS Commercial |
$442.20
|
|
|
TROCAR NON-BLADED 12X100MM Z-THREAD CTF73
|
Facility
IP
|
$597.00
|
|
| Hospital Charge Code |
5179400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.53 |
| Max. Negotiated Rate |
$549.24 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$549.24
|
| Rate for Payer: Health EOS Commercial |
$531.33
|
| Rate for Payer: HFN Commercial |
$549.24
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: NAPHCARE Commercial |
$358.20
|
| Rate for Payer: Preferred Network Access Commercial |
$549.24
|
| Rate for Payer: Quartz Beloit One Network |
$292.53
|
| Rate for Payer: Quartz Commercial |
$358.20
|
| Rate for Payer: WEA Trust Commercial |
$328.35
|
| Rate for Payer: WPS Commercial |
$442.20
|
|
