|
Basic Vestibular Evaluation 26
|
Facility
IP
|
$794.00
|
|
|
Service Code
|
CPT 92540 26
|
| Hospital Charge Code |
3203486
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$389.06 |
| Max. Negotiated Rate |
$730.48 |
| Rate for Payer: Aetna Commercial |
$714.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.82
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$730.48
|
| Rate for Payer: Health EOS Commercial |
$706.66
|
| Rate for Payer: HFN Commercial |
$730.48
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: NAPHCARE Commercial |
$476.40
|
| Rate for Payer: Preferred Network Access Commercial |
$730.48
|
| Rate for Payer: Quartz Beloit One Network |
$389.06
|
| Rate for Payer: Quartz Commercial |
$476.40
|
| Rate for Payer: WEA Trust Commercial |
$436.70
|
| Rate for Payer: WPS Commercial |
$588.12
|
|
|
Basic Vestibular Evaluation TC
|
Professional
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
1230809
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$30.37
|
| Rate for Payer: Anthem Medicare Advantage |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.37
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.37
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.37
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: Quartz Medicare Advantage |
$30.37
|
| Rate for Payer: The Alliance Commercial |
$75.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.37
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$121.48
|
|
|
Basic Vestibular Evaluation TC
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
1230809
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$45.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.66
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: Quartz Medicare Advantage |
$97.20
|
| Rate for Payer: The Alliance Commercial |
$648.00
|
| Rate for Payer: United Healthcare PPO |
$121.50
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Basic Vestibular Evaluation TC
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
1230809
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$97.20
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
BASKET 3.2FR NFORCE STONE
|
Facility
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,346.03 |
| Max. Negotiated Rate |
$2,527.24 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,648.20
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
BASKET 3.2FR NFORCE STONE
|
Facility
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.16 |
| Max. Negotiated Rate |
$10,988.00 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Aetna Managed Medicare |
$769.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.22
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.25
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,785.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.20
|
| Rate for Payer: The Alliance Commercial |
$10,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
BASKET 5-WIRE GEMINI HELICAL 330-115
|
Facility
OP
|
$2,412.00
|
|
| Hospital Charge Code |
2964804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$9,648.00 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Aetna Managed Medicare |
$675.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,567.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.76
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,809.00
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,567.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,447.20
|
| Rate for Payer: The Alliance Commercial |
$9,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
BASKET 5-WIRE GEMINI HELICAL 330-115
|
Facility
IP
|
$2,412.00
|
|
| Hospital Charge Code |
2964804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,181.88 |
| Max. Negotiated Rate |
$2,219.04 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,447.20
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
BASKET DAKOTA 1.9FR X 120CM X 8MM M0063905000
|
Facility
IP
|
$4,297.00
|
|
| Hospital Charge Code |
5286794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,105.53 |
| Max. Negotiated Rate |
$3,953.24 |
| Rate for Payer: Aetna Commercial |
$3,867.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.41
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cigna Commercial |
$3,953.24
|
| Rate for Payer: Health EOS Commercial |
$3,824.33
|
| Rate for Payer: HFN Commercial |
$3,953.24
|
| Rate for Payer: Multiplan Commercial |
$3,437.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,578.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.53
|
| Rate for Payer: Quartz Commercial |
$2,578.20
|
| Rate for Payer: WEA Trust Commercial |
$2,363.35
|
| Rate for Payer: WPS Commercial |
$3,182.79
|
|
|
BASKET DAKOTA 1.9FR X 120CM X 8MM M0063905000
|
Facility
OP
|
$4,297.00
|
|
| Hospital Charge Code |
5286794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,203.16 |
| Max. Negotiated Rate |
$17,188.00 |
| Rate for Payer: Aetna Commercial |
$3,867.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,695.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,203.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,793.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,148.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,062.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.41
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cigna Commercial |
$3,953.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,404.60
|
| Rate for Payer: Health EOS Commercial |
$3,824.33
|
| Rate for Payer: HFN Commercial |
$3,953.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,222.75
|
| Rate for Payer: Multiplan Commercial |
$3,437.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,578.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.53
|
| Rate for Payer: Quartz Commercial |
$2,793.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,578.20
|
| Rate for Payer: The Alliance Commercial |
$17,188.00
|
| Rate for Payer: WEA Trust Commercial |
$2,363.35
|
| Rate for Payer: WPS Commercial |
$3,182.79
|
|
|
BASKET ESCAPE NITINOL STONE RETRIEVAL 1.9FR X 120CM M0063902010
|
Facility
OP
|
$2,935.00
|
|
| Hospital Charge Code |
4595502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.80 |
| Max. Negotiated Rate |
$11,740.00 |
| Rate for Payer: Aetna Commercial |
$2,641.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.10
|
| Rate for Payer: Aetna Managed Medicare |
$821.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,907.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,408.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,555.55
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cigna Commercial |
$2,700.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.43
|
| Rate for Payer: Health EOS Commercial |
$2,612.15
|
| Rate for Payer: HFN Commercial |
$2,700.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.25
|
| Rate for Payer: Multiplan Commercial |
$2,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,700.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.15
|
| Rate for Payer: Quartz Commercial |
$1,907.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.00
|
| Rate for Payer: The Alliance Commercial |
$11,740.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.25
|
| Rate for Payer: WPS Commercial |
$2,173.95
|
|
|
BASKET ESCAPE NITINOL STONE RETRIEVAL 1.9FR X 120CM M0063902010
|
Facility
IP
|
$2,935.00
|
|
| Hospital Charge Code |
4595502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,438.15 |
| Max. Negotiated Rate |
$2,700.20 |
| Rate for Payer: Aetna Commercial |
$2,641.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,555.55
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cigna Commercial |
$2,700.20
|
| Rate for Payer: Health EOS Commercial |
$2,612.15
|
| Rate for Payer: HFN Commercial |
$2,700.20
|
| Rate for Payer: Multiplan Commercial |
$2,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,700.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.15
|
| Rate for Payer: Quartz Commercial |
$1,761.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.25
|
| Rate for Payer: WPS Commercial |
$2,173.95
|
|
|
BASKET GEMINI PAIRED 3.0FR X 120CM X 4-WIRE X 0 TIP HELICAL M0063301100
|
Facility
OP
|
$2,762.00
|
|
| Hospital Charge Code |
4520073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.36 |
| Max. Negotiated Rate |
$11,048.00 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| Rate for Payer: Aetna Managed Medicare |
$773.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,795.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,325.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,463.86
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,541.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,545.62
|
| Rate for Payer: Health EOS Commercial |
$2,458.18
|
| Rate for Payer: HFN Commercial |
$2,541.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,071.50
|
| Rate for Payer: Multiplan Commercial |
$2,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.38
|
| Rate for Payer: Quartz Commercial |
$1,795.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,657.20
|
| Rate for Payer: The Alliance Commercial |
$11,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,519.10
|
| Rate for Payer: WPS Commercial |
$2,045.81
|
|
|
BASKET GEMINI PAIRED 3.0FR X 120CM X 4-WIRE X 0 TIP HELICAL M0063301100
|
Facility
IP
|
$2,762.00
|
|
| Hospital Charge Code |
4520073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,353.38 |
| Max. Negotiated Rate |
$2,541.04 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,463.86
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,541.04
|
| Rate for Payer: Health EOS Commercial |
$2,458.18
|
| Rate for Payer: HFN Commercial |
$2,541.04
|
| Rate for Payer: Multiplan Commercial |
$2,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.38
|
| Rate for Payer: Quartz Commercial |
$1,657.20
|
| Rate for Payer: WEA Trust Commercial |
$1,519.10
|
| Rate for Payer: WPS Commercial |
$2,045.81
|
|
|
BASKET GEMINI PAIRED 3.0FR X 120CM X 4-WIRE X 5 TIP HELICAL M0063301110
|
Facility
OP
|
$2,762.00
|
|
| Hospital Charge Code |
5307034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.36 |
| Max. Negotiated Rate |
$11,048.00 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| Rate for Payer: Aetna Managed Medicare |
$773.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,795.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,325.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,463.86
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,541.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,545.62
|
| Rate for Payer: Health EOS Commercial |
$2,458.18
|
| Rate for Payer: HFN Commercial |
$2,541.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,071.50
|
| Rate for Payer: Multiplan Commercial |
$2,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.38
|
| Rate for Payer: Quartz Commercial |
$1,795.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,657.20
|
| Rate for Payer: The Alliance Commercial |
$11,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,519.10
|
| Rate for Payer: WPS Commercial |
$2,045.81
|
|
|
BASKET GEMINI PAIRED 3.0FR X 120CM X 4-WIRE X 5 TIP HELICAL M0063301110
|
Facility
IP
|
$2,762.00
|
|
| Hospital Charge Code |
5307034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,353.38 |
| Max. Negotiated Rate |
$2,541.04 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,463.86
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,541.04
|
| Rate for Payer: Health EOS Commercial |
$2,458.18
|
| Rate for Payer: HFN Commercial |
$2,541.04
|
| Rate for Payer: Multiplan Commercial |
$2,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.38
|
| Rate for Payer: Quartz Commercial |
$1,657.20
|
| Rate for Payer: WEA Trust Commercial |
$1,519.10
|
| Rate for Payer: WPS Commercial |
$2,045.81
|
|
|
BASKET GEMINI PAIRED 3.0FR X 90CM X 4-WIRE X 5CM TIP HELICAL M0063302090
|
Facility
OP
|
$2,762.00
|
|
| Hospital Charge Code |
5384851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.36 |
| Max. Negotiated Rate |
$11,048.00 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| Rate for Payer: Aetna Managed Medicare |
$773.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,795.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,325.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,463.86
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,541.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,545.62
|
| Rate for Payer: Health EOS Commercial |
$2,458.18
|
| Rate for Payer: HFN Commercial |
$2,541.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,071.50
|
| Rate for Payer: Multiplan Commercial |
$2,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.38
|
| Rate for Payer: Quartz Commercial |
$1,795.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,657.20
|
| Rate for Payer: The Alliance Commercial |
$11,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,519.10
|
| Rate for Payer: WPS Commercial |
$2,045.81
|
|
|
BASKET GEMINI PAIRED 3.0FR X 90CM X 4-WIRE X 5CM TIP HELICAL M0063302090
|
Facility
IP
|
$2,762.00
|
|
| Hospital Charge Code |
5384851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,353.38 |
| Max. Negotiated Rate |
$2,541.04 |
| Rate for Payer: Aetna Commercial |
$2,485.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,463.86
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,541.04
|
| Rate for Payer: Health EOS Commercial |
$2,458.18
|
| Rate for Payer: HFN Commercial |
$2,541.04
|
| Rate for Payer: Multiplan Commercial |
$2,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.38
|
| Rate for Payer: Quartz Commercial |
$1,657.20
|
| Rate for Payer: WEA Trust Commercial |
$1,519.10
|
| Rate for Payer: WPS Commercial |
$2,045.81
|
|
|
BASKET GEMINI PAIRED 3.0FR X 90CM X 5-WIRE X 5CM TIP HELICAL M0063302140
|
Facility
IP
|
$2,607.00
|
|
| Hospital Charge Code |
5457013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.43 |
| Max. Negotiated Rate |
$2,398.44 |
| Rate for Payer: Aetna Commercial |
$2,346.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.71
|
| Rate for Payer: Cash Price |
$782.10
|
| Rate for Payer: Cigna Commercial |
$2,398.44
|
| Rate for Payer: Health EOS Commercial |
$2,320.23
|
| Rate for Payer: HFN Commercial |
$2,398.44
|
| Rate for Payer: Multiplan Commercial |
$2,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,398.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.43
|
| Rate for Payer: Quartz Commercial |
$1,564.20
|
| Rate for Payer: WEA Trust Commercial |
$1,433.85
|
| Rate for Payer: WPS Commercial |
$1,931.00
|
|
|
BASKET GEMINI PAIRED 3.0FR X 90CM X 5-WIRE X 5CM TIP HELICAL M0063302140
|
Facility
OP
|
$2,607.00
|
|
| Hospital Charge Code |
5457013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.96 |
| Max. Negotiated Rate |
$10,428.00 |
| Rate for Payer: Aetna Commercial |
$2,346.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.02
|
| Rate for Payer: Aetna Managed Medicare |
$729.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,694.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,303.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.71
|
| Rate for Payer: Cash Price |
$782.10
|
| Rate for Payer: Cigna Commercial |
$2,398.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,458.88
|
| Rate for Payer: Health EOS Commercial |
$2,320.23
|
| Rate for Payer: HFN Commercial |
$2,398.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,955.25
|
| Rate for Payer: Multiplan Commercial |
$2,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,398.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.43
|
| Rate for Payer: Quartz Commercial |
$1,694.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.20
|
| Rate for Payer: The Alliance Commercial |
$10,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,433.85
|
| Rate for Payer: WPS Commercial |
$1,931.00
|
|
|
BASKET NCOMPASS NITINOL STONE
|
Facility
OP
|
$2,958.00
|
|
| Hospital Charge Code |
2964976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.24 |
| Max. Negotiated Rate |
$11,832.00 |
| Rate for Payer: Aetna Commercial |
$2,662.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.88
|
| Rate for Payer: Aetna Managed Medicare |
$828.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,922.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,479.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,419.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.74
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cigna Commercial |
$2,721.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,655.30
|
| Rate for Payer: Health EOS Commercial |
$2,632.62
|
| Rate for Payer: HFN Commercial |
$2,721.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,218.50
|
| Rate for Payer: Multiplan Commercial |
$2,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,774.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,721.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.42
|
| Rate for Payer: Quartz Commercial |
$1,922.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,774.80
|
| Rate for Payer: The Alliance Commercial |
$11,832.00
|
| Rate for Payer: WEA Trust Commercial |
$1,626.90
|
| Rate for Payer: WPS Commercial |
$2,190.99
|
|
|
BASKET NCOMPASS NITINOL STONE
|
Facility
IP
|
$2,958.00
|
|
| Hospital Charge Code |
2964976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,449.42 |
| Max. Negotiated Rate |
$2,721.36 |
| Rate for Payer: Aetna Commercial |
$2,662.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.74
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cigna Commercial |
$2,721.36
|
| Rate for Payer: Health EOS Commercial |
$2,632.62
|
| Rate for Payer: HFN Commercial |
$2,721.36
|
| Rate for Payer: Multiplan Commercial |
$2,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,774.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,721.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.42
|
| Rate for Payer: Quartz Commercial |
$1,774.80
|
| Rate for Payer: WEA Trust Commercial |
$1,626.90
|
| Rate for Payer: WPS Commercial |
$2,190.99
|
|
|
BASKET OPTI-FLEX NITINOL 1.3FR X 11MM X 20CM M0063903010
|
Facility
OP
|
$2,662.00
|
|
| Hospital Charge Code |
4520082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.36 |
| Max. Negotiated Rate |
$10,648.00 |
| Rate for Payer: Aetna Commercial |
$2,395.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,289.32
|
| Rate for Payer: Aetna Managed Medicare |
$745.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,730.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,331.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,277.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.86
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cigna Commercial |
$2,449.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,489.66
|
| Rate for Payer: Health EOS Commercial |
$2,369.18
|
| Rate for Payer: HFN Commercial |
$2,449.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,996.50
|
| Rate for Payer: Multiplan Commercial |
$2,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,597.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,449.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,304.38
|
| Rate for Payer: Quartz Commercial |
$1,730.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,597.20
|
| Rate for Payer: The Alliance Commercial |
$10,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,464.10
|
| Rate for Payer: WPS Commercial |
$1,971.74
|
|
|
BASKET OPTI-FLEX NITINOL 1.3FR X 11MM X 20CM M0063903010
|
Facility
IP
|
$2,662.00
|
|
| Hospital Charge Code |
4520082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,304.38 |
| Max. Negotiated Rate |
$2,449.04 |
| Rate for Payer: Aetna Commercial |
$2,395.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.86
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cigna Commercial |
$2,449.04
|
| Rate for Payer: Health EOS Commercial |
$2,369.18
|
| Rate for Payer: HFN Commercial |
$2,449.04
|
| Rate for Payer: Multiplan Commercial |
$2,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,597.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,449.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,304.38
|
| Rate for Payer: Quartz Commercial |
$1,597.20
|
| Rate for Payer: WEA Trust Commercial |
$1,464.10
|
| Rate for Payer: WPS Commercial |
$1,971.74
|
|
|
BASKET TRAPEZOID 2.0mm 1087
|
Facility
IP
|
$3,161.00
|
|
| Hospital Charge Code |
2973323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,548.89 |
| Max. Negotiated Rate |
$2,908.12 |
| Rate for Payer: Aetna Commercial |
$2,844.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,675.33
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$2,908.12
|
| Rate for Payer: Health EOS Commercial |
$2,813.29
|
| Rate for Payer: HFN Commercial |
$2,908.12
|
| Rate for Payer: Multiplan Commercial |
$2,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,896.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,908.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.89
|
| Rate for Payer: Quartz Commercial |
$1,896.60
|
| Rate for Payer: WEA Trust Commercial |
$1,738.55
|
| Rate for Payer: WPS Commercial |
$2,341.35
|
|
