|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,242.02
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,543.88
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,289.32
|
| 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 SEGURA HEMISHPERE 3FR X 120CM M0063801000
|
Facility
|
IP
|
$2,762.00
|
|
| Hospital Charge Code |
4595194
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,375.32
|
| 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 SEGURA HEMISHPERE 3FR X 120CM M0063801000
|
Facility
|
OP
|
$2,762.00
|
|
| Hospital Charge Code |
4595194
|
|
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 TRAPEZOID 2.0mm 1087
|
Facility
|
OP
|
$3,161.00
|
|
| Hospital Charge Code |
2973323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.08 |
| Max. Negotiated Rate |
$12,644.00 |
| Rate for Payer: Aetna Commercial |
$2,844.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,718.46
|
| Rate for Payer: Aetna Managed Medicare |
$885.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,054.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,580.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,517.28
|
| 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: Dean Health DHI/DHP/ASO |
$1,768.90
|
| Rate for Payer: Health EOS Commercial |
$2,813.29
|
| Rate for Payer: HFN Commercial |
$2,908.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,370.75
|
| 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 |
$2,054.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,896.60
|
| Rate for Payer: The Alliance Commercial |
$12,644.00
|
| Rate for Payer: WEA Trust Commercial |
$1,738.55
|
| Rate for Payer: WPS Commercial |
$2,341.35
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,718.46
|
| 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
|
|
|
BASKET TRAPEZOID 2.5mm 1088
|
Facility
|
IP
|
$3,161.00
|
|
| Hospital Charge Code |
2973324
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,718.46
|
| 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
|
|
|
BASKET TRAPEZOID 2.5mm 1088
|
Facility
|
OP
|
$3,161.00
|
|
| Hospital Charge Code |
2973324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.08 |
| Max. Negotiated Rate |
$12,644.00 |
| Rate for Payer: Aetna Commercial |
$2,844.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,718.46
|
| Rate for Payer: Aetna Managed Medicare |
$885.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,054.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,580.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,517.28
|
| 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: Dean Health DHI/DHP/ASO |
$1,768.90
|
| Rate for Payer: Health EOS Commercial |
$2,813.29
|
| Rate for Payer: HFN Commercial |
$2,908.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,370.75
|
| 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 |
$2,054.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,896.60
|
| Rate for Payer: The Alliance Commercial |
$12,644.00
|
| Rate for Payer: WEA Trust Commercial |
$1,738.55
|
| Rate for Payer: WPS Commercial |
$2,341.35
|
|
|
BASKET TRAPEZOID 3.0mm 1089
|
Facility
|
OP
|
$3,161.00
|
|
| Hospital Charge Code |
2973325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.08 |
| Max. Negotiated Rate |
$12,644.00 |
| Rate for Payer: Aetna Commercial |
$2,844.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,718.46
|
| Rate for Payer: Aetna Managed Medicare |
$885.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,054.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,580.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,517.28
|
| 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: Dean Health DHI/DHP/ASO |
$1,768.90
|
| Rate for Payer: Health EOS Commercial |
$2,813.29
|
| Rate for Payer: HFN Commercial |
$2,908.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,370.75
|
| 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 |
$2,054.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,896.60
|
| Rate for Payer: The Alliance Commercial |
$12,644.00
|
| Rate for Payer: WEA Trust Commercial |
$1,738.55
|
| Rate for Payer: WPS Commercial |
$2,341.35
|
|
|
BASKET TRAPEZOID 3.0mm 1089
|
Facility
|
IP
|
$3,161.00
|
|
| Hospital Charge Code |
2973325
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,718.46
|
| 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
|
|
|
BASKET ZERO TIP 3.0 X 120 M0063901030
|
Facility
|
IP
|
$2,591.00
|
|
| Hospital Charge Code |
2964805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,269.59 |
| Max. Negotiated Rate |
$2,383.72 |
| Rate for Payer: Aetna Commercial |
$2,331.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.23
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,383.72
|
| Rate for Payer: Health EOS Commercial |
$2,305.99
|
| Rate for Payer: HFN Commercial |
$2,383.72
|
| Rate for Payer: Multiplan Commercial |
$2,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.59
|
| Rate for Payer: Quartz Commercial |
$1,554.60
|
| Rate for Payer: WEA Trust Commercial |
$1,425.05
|
| Rate for Payer: WPS Commercial |
$1,919.15
|
|
|
BASKET ZERO TIP 3.0 X 120 M0063901030
|
Facility
|
OP
|
$2,591.00
|
|
| Hospital Charge Code |
2964805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.48 |
| Max. Negotiated Rate |
$10,364.00 |
| Rate for Payer: Aetna Commercial |
$2,331.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.26
|
| Rate for Payer: Aetna Managed Medicare |
$725.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,684.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,243.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.23
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,383.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,449.92
|
| Rate for Payer: Health EOS Commercial |
$2,305.99
|
| Rate for Payer: HFN Commercial |
$2,383.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,943.25
|
| Rate for Payer: Multiplan Commercial |
$2,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.59
|
| Rate for Payer: Quartz Commercial |
$1,684.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,554.60
|
| Rate for Payer: The Alliance Commercial |
$10,364.00
|
| Rate for Payer: WEA Trust Commercial |
$1,425.05
|
| Rate for Payer: WPS Commercial |
$1,919.15
|
|
|
BASKET ZERO TIP KNOT 1.9 X 120CM M0063901050
|
Facility
|
IP
|
$3,031.00
|
|
| Hospital Charge Code |
4594907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,485.19 |
| Max. Negotiated Rate |
$2,788.52 |
| Rate for Payer: Aetna Commercial |
$2,727.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,606.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,606.43
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,788.52
|
| Rate for Payer: Health EOS Commercial |
$2,697.59
|
| Rate for Payer: HFN Commercial |
$2,788.52
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,818.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,788.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.19
|
| Rate for Payer: Quartz Commercial |
$1,818.60
|
| Rate for Payer: WEA Trust Commercial |
$1,667.05
|
| Rate for Payer: WPS Commercial |
$2,245.06
|
|
|
BASKET ZERO TIP KNOT 1.9 X 120CM M0063901050
|
Facility
|
OP
|
$3,031.00
|
|
| Hospital Charge Code |
4594907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$848.68 |
| Max. Negotiated Rate |
$12,124.00 |
| Rate for Payer: Aetna Commercial |
$2,727.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,606.66
|
| Rate for Payer: Aetna Managed Medicare |
$848.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,970.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,515.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,454.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,606.43
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,788.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,696.15
|
| Rate for Payer: Health EOS Commercial |
$2,697.59
|
| Rate for Payer: HFN Commercial |
$2,788.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,273.25
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,818.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,788.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.19
|
| Rate for Payer: Quartz Commercial |
$1,970.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,818.60
|
| Rate for Payer: The Alliance Commercial |
$12,124.00
|
| Rate for Payer: WEA Trust Commercial |
$1,667.05
|
| Rate for Payer: WPS Commercial |
$2,245.06
|
|
