|
TROCAR BLADED 12X150MM CFB71
|
Facility
|
IP
|
$1,097.00
|
|
| Hospital Charge Code |
2963090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.03 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$684.53
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
TROCAR BLADED 12X150MM CFB71
|
Facility
|
OP
|
$1,097.00
|
|
| Hospital Charge Code |
2963090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.45 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Aetna Managed Medicare |
$319.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$741.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$570.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$638.45
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.66
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: NAPHCARE Commercial |
$684.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$741.57
|
| Rate for Payer: Quartz Medicare Advantage |
$684.53
|
| Rate for Payer: The Alliance Commercial |
$570.44
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
TROCAR BLADED 5X100MM CFB03
|
Facility
|
IP
|
$456.00
|
|
| Hospital Charge Code |
3092814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
TROCAR BLADED 5X100MM CFB03
|
Facility
|
OP
|
$456.00
|
|
| Hospital Charge Code |
3092814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Aetna Managed Medicare |
$132.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.39
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.68
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: NAPHCARE Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: Quartz Medicare Advantage |
$284.54
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
TROCAR BLADED KII 5X100MM CTB03
|
Facility
|
IP
|
$1,171.00
|
|
| Hospital Charge Code |
2962991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.74 |
| Max. Negotiated Rate |
$1,120.41 |
| Rate for Payer: Aetna Commercial |
$1,096.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.46
|
| Rate for Payer: Cash Price |
$351.30
|
| Rate for Payer: Cigna Commercial |
$1,120.41
|
| Rate for Payer: Health EOS Commercial |
$1,083.88
|
| Rate for Payer: HFN Commercial |
$1,120.41
|
| Rate for Payer: Multiplan Commercial |
$974.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.41
|
| Rate for Payer: Quartz Beloit One Network |
$596.74
|
| Rate for Payer: Quartz Commercial |
$730.70
|
| Rate for Payer: WEA Trust Commercial |
$669.81
|
| Rate for Payer: WPS Commercial |
$902.02
|
|
|
TROCAR BLADED KII 5X100MM CTB03
|
Facility
|
OP
|
$1,171.00
|
|
| Hospital Charge Code |
2962991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,120.41 |
| Rate for Payer: Aetna Commercial |
$1,096.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.34
|
| Rate for Payer: Aetna Managed Medicare |
$341.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$791.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$584.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.46
|
| Rate for Payer: Cash Price |
$351.30
|
| Rate for Payer: Cigna Commercial |
$1,120.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.52
|
| Rate for Payer: Health EOS Commercial |
$1,083.88
|
| Rate for Payer: HFN Commercial |
$1,120.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$913.38
|
| Rate for Payer: Multiplan Commercial |
$974.27
|
| Rate for Payer: NAPHCARE Commercial |
$730.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.41
|
| Rate for Payer: Quartz Beloit One Network |
$596.74
|
| Rate for Payer: Quartz Commercial |
$791.60
|
| Rate for Payer: Quartz Medicare Advantage |
$730.70
|
| Rate for Payer: The Alliance Commercial |
$608.92
|
| Rate for Payer: WEA Trust Commercial |
$669.81
|
| Rate for Payer: WPS Commercial |
$902.02
|
|
|
TROCAR KII BALLOON 12X100MM COR47
|
Facility
|
OP
|
$1,494.00
|
|
| Hospital Charge Code |
2963107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.05 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Aetna Managed Medicare |
$435.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.51
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.32
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: NAPHCARE Commercial |
$932.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$1,009.94
|
| Rate for Payer: Quartz Medicare Advantage |
$932.26
|
| Rate for Payer: The Alliance Commercial |
$776.88
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
TROCAR KII BALLOON 12X100MM COR47
|
Facility
|
IP
|
$1,494.00
|
|
| Hospital Charge Code |
2963107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.34 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$932.26
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
TROCAR KII BALLOON 12X150MM CFF71
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
5384671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.65
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$299.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
TROCAR KII BALLOON 12X150MM CFF71
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
5384671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
TROCAR KII BALLOON 5X150MM CFF01
|
Facility
|
OP
|
$439.00
|
|
| Hospital Charge Code |
5384672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.50
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$228.28
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR KII BALLOON 5X150MM CFF01
|
Facility
|
IP
|
$439.00
|
|
| Hospital Charge Code |
5384672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR KII BLADED 12X100MM CTB73
|
Facility
|
IP
|
$1,214.00
|
|
| Hospital Charge Code |
2963089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.65 |
| Max. Negotiated Rate |
$1,161.56 |
| Rate for Payer: Aetna Commercial |
$1,136.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.16
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,161.56
|
| Rate for Payer: Health EOS Commercial |
$1,123.68
|
| Rate for Payer: HFN Commercial |
$1,161.56
|
| Rate for Payer: Multiplan Commercial |
$1,010.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.56
|
| Rate for Payer: Quartz Beloit One Network |
$618.65
|
| Rate for Payer: Quartz Commercial |
$757.54
|
| Rate for Payer: WEA Trust Commercial |
$694.41
|
| Rate for Payer: WPS Commercial |
$935.14
|
|
|
TROCAR KII BLADED 12X100MM CTB73
|
Facility
|
OP
|
$1,214.00
|
|
| Hospital Charge Code |
2963089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.52 |
| Max. Negotiated Rate |
$1,161.56 |
| Rate for Payer: Aetna Commercial |
$1,136.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.80
|
| Rate for Payer: Aetna Managed Medicare |
$353.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$820.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$631.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$606.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.16
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,161.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.55
|
| Rate for Payer: Health EOS Commercial |
$1,123.68
|
| Rate for Payer: HFN Commercial |
$1,161.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$946.92
|
| Rate for Payer: Multiplan Commercial |
$1,010.05
|
| Rate for Payer: NAPHCARE Commercial |
$757.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.56
|
| Rate for Payer: Quartz Beloit One Network |
$618.65
|
| Rate for Payer: Quartz Commercial |
$820.66
|
| Rate for Payer: Quartz Medicare Advantage |
$757.54
|
| Rate for Payer: The Alliance Commercial |
$631.28
|
| Rate for Payer: WEA Trust Commercial |
$694.41
|
| Rate for Payer: WPS Commercial |
$935.14
|
|
|
TROCAR NON-BLADED 12X100MM Z-THREAD CTF73
|
Facility
|
OP
|
$597.00
|
|
| Hospital Charge Code |
5179400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.85 |
| Max. Negotiated Rate |
$571.21 |
| Rate for Payer: Aetna Commercial |
$558.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.96
|
| Rate for Payer: Aetna Managed Medicare |
$173.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.07
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$571.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.45
|
| Rate for Payer: Health EOS Commercial |
$552.58
|
| Rate for Payer: HFN Commercial |
$571.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.66
|
| Rate for Payer: Multiplan Commercial |
$496.70
|
| Rate for Payer: NAPHCARE Commercial |
$372.53
|
| Rate for Payer: Preferred Network Access Commercial |
$571.21
|
| Rate for Payer: Quartz Beloit One Network |
$304.23
|
| Rate for Payer: Quartz Commercial |
$403.57
|
| Rate for Payer: Quartz Medicare Advantage |
$372.53
|
| Rate for Payer: The Alliance Commercial |
$310.44
|
| Rate for Payer: WEA Trust Commercial |
$341.48
|
| Rate for Payer: WPS Commercial |
$459.87
|
|
|
TROCAR NON-BLADED 12X100MM Z-THREAD CTF73
|
Facility
|
IP
|
$597.00
|
|
| Hospital Charge Code |
5179400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.23 |
| Max. Negotiated Rate |
$571.21 |
| Rate for Payer: Aetna Commercial |
$558.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.07
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$571.21
|
| Rate for Payer: Health EOS Commercial |
$552.58
|
| Rate for Payer: HFN Commercial |
$571.21
|
| Rate for Payer: Multiplan Commercial |
$496.70
|
| Rate for Payer: Preferred Network Access Commercial |
$571.21
|
| Rate for Payer: Quartz Beloit One Network |
$304.23
|
| Rate for Payer: Quartz Commercial |
$372.53
|
| Rate for Payer: WEA Trust Commercial |
$341.48
|
| Rate for Payer: WPS Commercial |
$459.87
|
|
|
TROCAR NON-BLADED 12X150MM Z-THREAD CTF71
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
5384673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
TROCAR NON-BLADED 12X150MM Z-THREAD CTF71
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
5384673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.65
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$299.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
TROCAR NON-BLADED 5X100MM BALLOON CFF03
|
Facility
|
IP
|
$439.00
|
|
| Hospital Charge Code |
5179325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR NON-BLADED 5X100MM BALLOON CFF03
|
Facility
|
OP
|
$439.00
|
|
| Hospital Charge Code |
5179325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.50
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$228.28
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR NON-BLADED 5X100MM Z-THREAD CTF03
|
Facility
|
IP
|
$439.00
|
|
| Hospital Charge Code |
5179324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR NON-BLADED 5X100MM Z-THREAD CTF03
|
Facility
|
OP
|
$439.00
|
|
| Hospital Charge Code |
5179324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.50
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$228.28
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR NON-BLADED 5X150MM Z-THREAD CTF01
|
Facility
|
IP
|
$439.00
|
|
| Hospital Charge Code |
5384674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR NON-BLADED 5X150MM Z-THREAD CTF01
|
Facility
|
OP
|
$439.00
|
|
| Hospital Charge Code |
5384674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.50
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$228.28
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TROCAR SLEEVE 5X100MM Z-THREAD CTS02
|
Facility
|
OP
|
$219.00
|
|
| Hospital Charge Code |
5179326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.77 |
| Max. Negotiated Rate |
$209.54 |
| Rate for Payer: Aetna Commercial |
$204.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.87
|
| Rate for Payer: Aetna Managed Medicare |
$63.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.71
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$209.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.46
|
| Rate for Payer: Health EOS Commercial |
$202.71
|
| Rate for Payer: HFN Commercial |
$209.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.82
|
| Rate for Payer: Multiplan Commercial |
$182.21
|
| Rate for Payer: NAPHCARE Commercial |
$136.66
|
| Rate for Payer: Preferred Network Access Commercial |
$209.54
|
| Rate for Payer: Quartz Beloit One Network |
$111.60
|
| Rate for Payer: Quartz Commercial |
$148.04
|
| Rate for Payer: Quartz Medicare Advantage |
$136.66
|
| Rate for Payer: The Alliance Commercial |
$113.88
|
| Rate for Payer: WEA Trust Commercial |
$125.27
|
| Rate for Payer: WPS Commercial |
$168.70
|
|
