|
BASKET 5-WIRE GEMINI HELICAL 330-115
|
Facility
|
IP
|
$2,412.00
|
|
| Hospital Charge Code |
2964804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,229.16 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,505.09
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
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 |
$1,251.29 |
| Max. Negotiated Rate |
$4,111.37 |
| Rate for Payer: Aetna Commercial |
$4,021.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,843.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,904.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,234.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,145.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,368.51
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cigna Commercial |
$4,111.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,500.85
|
| Rate for Payer: Health EOS Commercial |
$3,977.30
|
| Rate for Payer: HFN Commercial |
$4,111.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,351.66
|
| Rate for Payer: Multiplan Commercial |
$3,575.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,681.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,111.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.75
|
| Rate for Payer: Quartz Commercial |
$2,904.77
|
| Rate for Payer: Quartz Medicare Advantage |
$2,681.33
|
| Rate for Payer: The Alliance Commercial |
$2,234.44
|
| Rate for Payer: WEA Trust Commercial |
$2,457.88
|
| Rate for Payer: WPS Commercial |
$3,309.98
|
|
|
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 |
$2,189.75 |
| Max. Negotiated Rate |
$4,111.37 |
| Rate for Payer: Aetna Commercial |
$4,021.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,843.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,368.51
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cigna Commercial |
$4,111.37
|
| Rate for Payer: Health EOS Commercial |
$3,977.30
|
| Rate for Payer: HFN Commercial |
$4,111.37
|
| Rate for Payer: Multiplan Commercial |
$3,575.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,111.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.75
|
| Rate for Payer: Quartz Commercial |
$2,681.33
|
| Rate for Payer: WEA Trust Commercial |
$2,457.88
|
| Rate for Payer: WPS Commercial |
$3,309.98
|
|
|
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 |
$1,495.68 |
| Max. Negotiated Rate |
$2,808.21 |
| Rate for Payer: Aetna Commercial |
$2,747.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,617.77
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cigna Commercial |
$2,808.21
|
| Rate for Payer: Health EOS Commercial |
$2,716.64
|
| Rate for Payer: HFN Commercial |
$2,808.21
|
| Rate for Payer: Multiplan Commercial |
$2,441.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,808.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,495.68
|
| Rate for Payer: Quartz Commercial |
$1,831.44
|
| Rate for Payer: WEA Trust Commercial |
$1,678.82
|
| Rate for Payer: WPS Commercial |
$2,260.83
|
|
|
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 |
$854.67 |
| Max. Negotiated Rate |
$2,808.21 |
| Rate for Payer: Aetna Commercial |
$2,747.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.06
|
| Rate for Payer: Aetna Managed Medicare |
$854.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,984.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,526.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,465.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,617.77
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cigna Commercial |
$2,808.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,708.17
|
| Rate for Payer: Health EOS Commercial |
$2,716.64
|
| Rate for Payer: HFN Commercial |
$2,808.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,289.30
|
| Rate for Payer: Multiplan Commercial |
$2,441.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,831.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,808.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,495.68
|
| Rate for Payer: Quartz Commercial |
$1,984.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,831.44
|
| Rate for Payer: The Alliance Commercial |
$1,526.20
|
| Rate for Payer: WEA Trust Commercial |
$1,678.82
|
| Rate for Payer: WPS Commercial |
$2,260.83
|
|
|
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 |
$804.29 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Aetna Managed Medicare |
$804.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,867.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,436.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,378.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,607.48
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,154.36
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,723.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,867.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,723.49
|
| Rate for Payer: The Alliance Commercial |
$1,436.24
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
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 |
$1,407.52 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,723.49
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
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 |
$1,407.52 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,723.49
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
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 |
$804.29 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Aetna Managed Medicare |
$804.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,867.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,436.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,378.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,607.48
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,154.36
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,723.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,867.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,723.49
|
| Rate for Payer: The Alliance Commercial |
$1,436.24
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
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 |
$804.29 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Aetna Managed Medicare |
$804.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,867.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,436.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,378.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,607.48
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,154.36
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,723.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,867.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,723.49
|
| Rate for Payer: The Alliance Commercial |
$1,436.24
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
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 |
$1,407.52 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,723.49
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
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 |
$1,328.53 |
| Max. Negotiated Rate |
$2,494.38 |
| Rate for Payer: Aetna Commercial |
$2,440.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,331.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,436.98
|
| Rate for Payer: Cash Price |
$782.10
|
| Rate for Payer: Cigna Commercial |
$2,494.38
|
| Rate for Payer: Health EOS Commercial |
$2,413.04
|
| Rate for Payer: HFN Commercial |
$2,494.38
|
| Rate for Payer: Multiplan Commercial |
$2,169.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,494.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.53
|
| Rate for Payer: Quartz Commercial |
$1,626.77
|
| Rate for Payer: WEA Trust Commercial |
$1,491.20
|
| Rate for Payer: WPS Commercial |
$2,008.17
|
|
|
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 |
$759.16 |
| Max. Negotiated Rate |
$2,494.38 |
| Rate for Payer: Aetna Commercial |
$2,440.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,331.70
|
| Rate for Payer: Aetna Managed Medicare |
$759.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,762.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,355.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,436.98
|
| Rate for Payer: Cash Price |
$782.10
|
| Rate for Payer: Cigna Commercial |
$2,494.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,517.27
|
| Rate for Payer: Health EOS Commercial |
$2,413.04
|
| Rate for Payer: HFN Commercial |
$2,494.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,033.46
|
| Rate for Payer: Multiplan Commercial |
$2,169.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,626.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,494.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.53
|
| Rate for Payer: Quartz Commercial |
$1,762.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,626.77
|
| Rate for Payer: The Alliance Commercial |
$1,355.64
|
| Rate for Payer: WEA Trust Commercial |
$1,491.20
|
| Rate for Payer: WPS Commercial |
$2,008.17
|
|
|
BASKET NCOMPASS NITINOL STONE
|
Facility
|
OP
|
$2,958.00
|
|
| Hospital Charge Code |
2964976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$861.37 |
| Max. Negotiated Rate |
$2,830.21 |
| Rate for Payer: Aetna Commercial |
$2,768.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,645.64
|
| Rate for Payer: Aetna Managed Medicare |
$861.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,999.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,538.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,476.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,630.45
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cigna Commercial |
$2,830.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,721.56
|
| Rate for Payer: Health EOS Commercial |
$2,737.92
|
| Rate for Payer: HFN Commercial |
$2,830.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,307.24
|
| Rate for Payer: Multiplan Commercial |
$2,461.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,845.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,830.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.40
|
| Rate for Payer: Quartz Commercial |
$1,999.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,845.79
|
| Rate for Payer: The Alliance Commercial |
$1,538.16
|
| Rate for Payer: WEA Trust Commercial |
$1,691.98
|
| Rate for Payer: WPS Commercial |
$2,278.55
|
|
|
BASKET NCOMPASS NITINOL STONE
|
Facility
|
IP
|
$2,958.00
|
|
| Hospital Charge Code |
2964976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,507.40 |
| Max. Negotiated Rate |
$2,830.21 |
| Rate for Payer: Aetna Commercial |
$2,768.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,645.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,630.45
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cigna Commercial |
$2,830.21
|
| Rate for Payer: Health EOS Commercial |
$2,737.92
|
| Rate for Payer: HFN Commercial |
$2,830.21
|
| Rate for Payer: Multiplan Commercial |
$2,461.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,830.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.40
|
| Rate for Payer: Quartz Commercial |
$1,845.79
|
| Rate for Payer: WEA Trust Commercial |
$1,691.98
|
| Rate for Payer: WPS Commercial |
$2,278.55
|
|
|
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 |
$775.17 |
| Max. Negotiated Rate |
$2,547.00 |
| Rate for Payer: Aetna Commercial |
$2,491.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.89
|
| Rate for Payer: Aetna Managed Medicare |
$775.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,799.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,384.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,328.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,467.29
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cigna Commercial |
$2,547.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,549.28
|
| Rate for Payer: Health EOS Commercial |
$2,463.95
|
| Rate for Payer: HFN Commercial |
$2,547.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,076.36
|
| Rate for Payer: Multiplan Commercial |
$2,214.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,661.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,547.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.56
|
| Rate for Payer: Quartz Commercial |
$1,799.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,661.09
|
| Rate for Payer: The Alliance Commercial |
$1,384.24
|
| Rate for Payer: WEA Trust Commercial |
$1,522.66
|
| Rate for Payer: WPS Commercial |
$2,050.54
|
|
|
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 |
$1,356.56 |
| Max. Negotiated Rate |
$2,547.00 |
| Rate for Payer: Aetna Commercial |
$2,491.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,467.29
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cigna Commercial |
$2,547.00
|
| Rate for Payer: Health EOS Commercial |
$2,463.95
|
| Rate for Payer: HFN Commercial |
$2,547.00
|
| Rate for Payer: Multiplan Commercial |
$2,214.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,547.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.56
|
| Rate for Payer: Quartz Commercial |
$1,661.09
|
| Rate for Payer: WEA Trust Commercial |
$1,522.66
|
| Rate for Payer: WPS Commercial |
$2,050.54
|
|
|
BASKET SEGURA HEMISHPERE 3FR X 120CM M0063801000
|
Facility
|
OP
|
$2,762.00
|
|
| Hospital Charge Code |
4595194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.29 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Aetna Managed Medicare |
$804.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,867.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,436.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,378.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,607.48
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,154.36
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,723.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,867.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,723.49
|
| Rate for Payer: The Alliance Commercial |
$1,436.24
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
BASKET SEGURA HEMISHPERE 3FR X 120CM M0063801000
|
Facility
|
IP
|
$2,762.00
|
|
| Hospital Charge Code |
4595194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,407.52 |
| Max. Negotiated Rate |
$2,642.68 |
| Rate for Payer: Aetna Commercial |
$2,585.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,470.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.41
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$2,642.68
|
| Rate for Payer: Health EOS Commercial |
$2,556.51
|
| Rate for Payer: HFN Commercial |
$2,642.68
|
| Rate for Payer: Multiplan Commercial |
$2,297.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,642.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.52
|
| Rate for Payer: Quartz Commercial |
$1,723.49
|
| Rate for Payer: WEA Trust Commercial |
$1,579.86
|
| Rate for Payer: WPS Commercial |
$2,127.57
|
|
|
BASKET TRAPEZOID 2.0mm 1087
|
Facility
|
OP
|
$3,161.00
|
|
| Hospital Charge Code |
2973323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$920.48 |
| Max. Negotiated Rate |
$3,024.44 |
| Rate for Payer: Aetna Commercial |
$2,958.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,827.20
|
| Rate for Payer: Aetna Managed Medicare |
$920.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.34
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$3,024.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.70
|
| Rate for Payer: Health EOS Commercial |
$2,925.82
|
| Rate for Payer: HFN Commercial |
$3,024.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.58
|
| Rate for Payer: Multiplan Commercial |
$2,629.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.85
|
| Rate for Payer: Quartz Commercial |
$2,136.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.46
|
| Rate for Payer: The Alliance Commercial |
$1,643.72
|
| Rate for Payer: WEA Trust Commercial |
$1,808.09
|
| Rate for Payer: WPS Commercial |
$2,434.92
|
|
|
BASKET TRAPEZOID 2.0mm 1087
|
Facility
|
IP
|
$3,161.00
|
|
| Hospital Charge Code |
2973323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,610.85 |
| Max. Negotiated Rate |
$3,024.44 |
| Rate for Payer: Aetna Commercial |
$2,958.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,827.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.34
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$3,024.44
|
| Rate for Payer: Health EOS Commercial |
$2,925.82
|
| Rate for Payer: HFN Commercial |
$3,024.44
|
| Rate for Payer: Multiplan Commercial |
$2,629.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.85
|
| Rate for Payer: Quartz Commercial |
$1,972.46
|
| Rate for Payer: WEA Trust Commercial |
$1,808.09
|
| Rate for Payer: WPS Commercial |
$2,434.92
|
|
|
BASKET TRAPEZOID 2.5mm 1088
|
Facility
|
IP
|
$3,161.00
|
|
| Hospital Charge Code |
2973324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,610.85 |
| Max. Negotiated Rate |
$3,024.44 |
| Rate for Payer: Aetna Commercial |
$2,958.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,827.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.34
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$3,024.44
|
| Rate for Payer: Health EOS Commercial |
$2,925.82
|
| Rate for Payer: HFN Commercial |
$3,024.44
|
| Rate for Payer: Multiplan Commercial |
$2,629.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.85
|
| Rate for Payer: Quartz Commercial |
$1,972.46
|
| Rate for Payer: WEA Trust Commercial |
$1,808.09
|
| Rate for Payer: WPS Commercial |
$2,434.92
|
|
|
BASKET TRAPEZOID 2.5mm 1088
|
Facility
|
OP
|
$3,161.00
|
|
| Hospital Charge Code |
2973324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$920.48 |
| Max. Negotiated Rate |
$3,024.44 |
| Rate for Payer: Aetna Commercial |
$2,958.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,827.20
|
| Rate for Payer: Aetna Managed Medicare |
$920.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.34
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$3,024.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.70
|
| Rate for Payer: Health EOS Commercial |
$2,925.82
|
| Rate for Payer: HFN Commercial |
$3,024.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.58
|
| Rate for Payer: Multiplan Commercial |
$2,629.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.85
|
| Rate for Payer: Quartz Commercial |
$2,136.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.46
|
| Rate for Payer: The Alliance Commercial |
$1,643.72
|
| Rate for Payer: WEA Trust Commercial |
$1,808.09
|
| Rate for Payer: WPS Commercial |
$2,434.92
|
|
|
BASKET TRAPEZOID 3.0mm 1089
|
Facility
|
IP
|
$3,161.00
|
|
| Hospital Charge Code |
2973325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,610.85 |
| Max. Negotiated Rate |
$3,024.44 |
| Rate for Payer: Aetna Commercial |
$2,958.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,827.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.34
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$3,024.44
|
| Rate for Payer: Health EOS Commercial |
$2,925.82
|
| Rate for Payer: HFN Commercial |
$3,024.44
|
| Rate for Payer: Multiplan Commercial |
$2,629.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.85
|
| Rate for Payer: Quartz Commercial |
$1,972.46
|
| Rate for Payer: WEA Trust Commercial |
$1,808.09
|
| Rate for Payer: WPS Commercial |
$2,434.92
|
|
|
BASKET TRAPEZOID 3.0mm 1089
|
Facility
|
OP
|
$3,161.00
|
|
| Hospital Charge Code |
2973325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$920.48 |
| Max. Negotiated Rate |
$3,024.44 |
| Rate for Payer: Aetna Commercial |
$2,958.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,827.20
|
| Rate for Payer: Aetna Managed Medicare |
$920.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.34
|
| Rate for Payer: Cash Price |
$948.30
|
| Rate for Payer: Cigna Commercial |
$3,024.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.70
|
| Rate for Payer: Health EOS Commercial |
$2,925.82
|
| Rate for Payer: HFN Commercial |
$3,024.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.58
|
| Rate for Payer: Multiplan Commercial |
$2,629.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.85
|
| Rate for Payer: Quartz Commercial |
$2,136.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.46
|
| Rate for Payer: The Alliance Commercial |
$1,643.72
|
| Rate for Payer: WEA Trust Commercial |
$1,808.09
|
| Rate for Payer: WPS Commercial |
$2,434.92
|
|
