|
Disposable Bvm Mask Infant
|
Facility
IP
|
$48.00
|
|
| Hospital Charge Code |
3040343
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Disposable Bvm Mask Infant
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
3040343
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Disposable Bvm - Pediatric
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
3040342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Disposable Bvm - Pediatric
|
Facility
IP
|
$49.00
|
|
| Hospital Charge Code |
3040342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
DISPOSABLE ENDOSCOPIC GASTROCNEMIUS RECESSION EGR EXPRESS 3200-D
|
Facility
OP
|
$3,246.00
|
|
| Hospital Charge Code |
6151664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$908.88 |
| Max. Negotiated Rate |
$12,984.00 |
| Rate for Payer: Aetna Commercial |
$2,921.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,791.56
|
| Rate for Payer: Aetna Managed Medicare |
$908.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,109.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,623.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,558.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,720.38
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cigna Commercial |
$2,986.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,816.46
|
| Rate for Payer: Health EOS Commercial |
$2,888.94
|
| Rate for Payer: HFN Commercial |
$2,986.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,434.50
|
| Rate for Payer: Multiplan Commercial |
$2,596.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,947.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,986.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,590.54
|
| Rate for Payer: Quartz Commercial |
$2,109.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,947.60
|
| Rate for Payer: The Alliance Commercial |
$12,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,785.30
|
| Rate for Payer: WPS Commercial |
$2,404.31
|
|
|
DISPOSABLE ENDOSCOPIC GASTROCNEMIUS RECESSION EGR EXPRESS 3200-D
|
Facility
IP
|
$3,246.00
|
|
| Hospital Charge Code |
6151664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,590.54 |
| Max. Negotiated Rate |
$2,986.32 |
| Rate for Payer: Aetna Commercial |
$2,921.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,720.38
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cigna Commercial |
$2,986.32
|
| Rate for Payer: Health EOS Commercial |
$2,888.94
|
| Rate for Payer: HFN Commercial |
$2,986.32
|
| Rate for Payer: Multiplan Commercial |
$2,596.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,947.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,986.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,590.54
|
| Rate for Payer: Quartz Commercial |
$1,947.60
|
| Rate for Payer: WEA Trust Commercial |
$1,785.30
|
| Rate for Payer: WPS Commercial |
$2,404.31
|
|
|
DISPOSABLE INSTRUMENT KIT MINI S-TAK AR-1322DSC
|
Facility
IP
|
$2,659.00
|
|
| Hospital Charge Code |
5384919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,302.91 |
| Max. Negotiated Rate |
$2,446.28 |
| Rate for Payer: Aetna Commercial |
$2,393.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.27
|
| Rate for Payer: Cash Price |
$797.70
|
| Rate for Payer: Cigna Commercial |
$2,446.28
|
| Rate for Payer: Health EOS Commercial |
$2,366.51
|
| Rate for Payer: HFN Commercial |
$2,446.28
|
| Rate for Payer: Multiplan Commercial |
$2,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.91
|
| Rate for Payer: Quartz Commercial |
$1,595.40
|
| Rate for Payer: WEA Trust Commercial |
$1,462.45
|
| Rate for Payer: WPS Commercial |
$1,969.52
|
|
|
DISPOSABLE INSTRUMENT KIT MINI S-TAK AR-1322DSC
|
Facility
OP
|
$2,659.00
|
|
| Hospital Charge Code |
5384919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.52 |
| Max. Negotiated Rate |
$10,636.00 |
| Rate for Payer: Aetna Commercial |
$2,393.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.74
|
| Rate for Payer: Aetna Managed Medicare |
$744.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.27
|
| Rate for Payer: Cash Price |
$797.70
|
| Rate for Payer: Cigna Commercial |
$2,446.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,487.98
|
| Rate for Payer: Health EOS Commercial |
$2,366.51
|
| Rate for Payer: HFN Commercial |
$2,446.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.25
|
| Rate for Payer: Multiplan Commercial |
$2,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.91
|
| Rate for Payer: Quartz Commercial |
$1,728.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.40
|
| Rate for Payer: The Alliance Commercial |
$10,636.00
|
| Rate for Payer: WEA Trust Commercial |
$1,462.45
|
| Rate for Payer: WPS Commercial |
$1,969.52
|
|
|
DISPOSABLE KIT 2.4MM PUSHLOCK AR-2924DHS
|
Facility
OP
|
$2,705.00
|
|
| Hospital Charge Code |
5414767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.40 |
| Max. Negotiated Rate |
$10,820.00 |
| Rate for Payer: Aetna Commercial |
$2,434.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,326.30
|
| Rate for Payer: Aetna Managed Medicare |
$757.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,758.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,352.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,298.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.65
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$2,488.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,513.72
|
| Rate for Payer: Health EOS Commercial |
$2,407.45
|
| Rate for Payer: HFN Commercial |
$2,488.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.75
|
| Rate for Payer: Multiplan Commercial |
$2,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.45
|
| Rate for Payer: Quartz Commercial |
$1,758.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,623.00
|
| Rate for Payer: The Alliance Commercial |
$10,820.00
|
| Rate for Payer: WEA Trust Commercial |
$1,487.75
|
| Rate for Payer: WPS Commercial |
$2,003.59
|
|
|
DISPOSABLE KIT 2.4MM PUSHLOCK AR-2924DHS
|
Facility
IP
|
$2,705.00
|
|
| Hospital Charge Code |
5414767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.45 |
| Max. Negotiated Rate |
$2,488.60 |
| Rate for Payer: Aetna Commercial |
$2,434.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.65
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$2,488.60
|
| Rate for Payer: Health EOS Commercial |
$2,407.45
|
| Rate for Payer: HFN Commercial |
$2,488.60
|
| Rate for Payer: Multiplan Commercial |
$2,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.45
|
| Rate for Payer: Quartz Commercial |
$1,623.00
|
| Rate for Payer: WEA Trust Commercial |
$1,487.75
|
| Rate for Payer: WPS Commercial |
$2,003.59
|
|
|
DISPOSABLE KIT 2.9MM PUSHLOCK AR-2923DS
|
Facility
IP
|
$2,459.00
|
|
| Hospital Charge Code |
5349154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,204.91 |
| Max. Negotiated Rate |
$2,262.28 |
| Rate for Payer: Aetna Commercial |
$2,213.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,303.27
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cigna Commercial |
$2,262.28
|
| Rate for Payer: Health EOS Commercial |
$2,188.51
|
| Rate for Payer: HFN Commercial |
$2,262.28
|
| Rate for Payer: Multiplan Commercial |
$1,967.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,475.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,262.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.91
|
| Rate for Payer: Quartz Commercial |
$1,475.40
|
| Rate for Payer: WEA Trust Commercial |
$1,352.45
|
| Rate for Payer: WPS Commercial |
$1,821.38
|
|
|
DISPOSABLE KIT 2.9MM PUSHLOCK AR-2923DS
|
Facility
OP
|
$2,459.00
|
|
| Hospital Charge Code |
5349154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$688.52 |
| Max. Negotiated Rate |
$9,836.00 |
| Rate for Payer: Aetna Commercial |
$2,213.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,114.74
|
| Rate for Payer: Aetna Managed Medicare |
$688.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,598.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,229.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,180.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,303.27
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cigna Commercial |
$2,262.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,376.06
|
| Rate for Payer: Health EOS Commercial |
$2,188.51
|
| Rate for Payer: HFN Commercial |
$2,262.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,844.25
|
| Rate for Payer: Multiplan Commercial |
$1,967.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,475.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,262.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.91
|
| Rate for Payer: Quartz Commercial |
$1,598.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,475.40
|
| Rate for Payer: The Alliance Commercial |
$9,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,352.45
|
| Rate for Payer: WPS Commercial |
$1,821.38
|
|
|
DISPOSABLE KIT PUSHLOCK 2.9MM AR-1923DS
|
Facility
IP
|
$3,049.00
|
|
| Hospital Charge Code |
3072506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.01 |
| Max. Negotiated Rate |
$2,805.08 |
| Rate for Payer: Aetna Commercial |
$2,744.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.97
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,805.08
|
| Rate for Payer: Health EOS Commercial |
$2,713.61
|
| Rate for Payer: HFN Commercial |
$2,805.08
|
| Rate for Payer: Multiplan Commercial |
$2,439.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,829.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,805.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.01
|
| Rate for Payer: Quartz Commercial |
$1,829.40
|
| Rate for Payer: WEA Trust Commercial |
$1,676.95
|
| Rate for Payer: WPS Commercial |
$2,258.39
|
|
|
DISPOSABLE KIT PUSHLOCK 2.9MM AR-1923DS
|
Facility
OP
|
$3,049.00
|
|
| Hospital Charge Code |
3072506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.72 |
| Max. Negotiated Rate |
$12,196.00 |
| Rate for Payer: Aetna Commercial |
$2,744.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,622.14
|
| Rate for Payer: Aetna Managed Medicare |
$853.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,981.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,524.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,463.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.97
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,805.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,706.22
|
| Rate for Payer: Health EOS Commercial |
$2,713.61
|
| Rate for Payer: HFN Commercial |
$2,805.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,286.75
|
| Rate for Payer: Multiplan Commercial |
$2,439.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,829.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,805.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.01
|
| Rate for Payer: Quartz Commercial |
$1,981.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,829.40
|
| Rate for Payer: The Alliance Commercial |
$12,196.00
|
| Rate for Payer: WEA Trust Commercial |
$1,676.95
|
| Rate for Payer: WPS Commercial |
$2,258.39
|
|
|
DISPOSABLE KIT T3 AMZ AR-13217
|
Facility
OP
|
$5,916.00
|
|
| Hospital Charge Code |
5521096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,656.48 |
| Max. Negotiated Rate |
$23,664.00 |
| Rate for Payer: Aetna Commercial |
$5,324.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,087.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,845.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,958.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,839.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,135.48
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cigna Commercial |
$5,442.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,310.59
|
| Rate for Payer: Health EOS Commercial |
$5,265.24
|
| Rate for Payer: HFN Commercial |
$5,442.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,437.00
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,442.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,898.84
|
| Rate for Payer: Quartz Commercial |
$3,845.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,549.60
|
| Rate for Payer: The Alliance Commercial |
$23,664.00
|
| Rate for Payer: WEA Trust Commercial |
$3,253.80
|
| Rate for Payer: WPS Commercial |
$4,381.98
|
|
|
DISPOSABLE KIT T3 AMZ AR-13217
|
Facility
IP
|
$5,916.00
|
|
| Hospital Charge Code |
5521096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,898.84 |
| Max. Negotiated Rate |
$5,442.72 |
| Rate for Payer: Aetna Commercial |
$5,324.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,135.48
|
| Rate for Payer: Cash Price |
$1,774.80
|
| Rate for Payer: Cigna Commercial |
$5,442.72
|
| Rate for Payer: Health EOS Commercial |
$5,265.24
|
| Rate for Payer: HFN Commercial |
$5,442.72
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,442.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,898.84
|
| Rate for Payer: Quartz Commercial |
$3,549.60
|
| Rate for Payer: WEA Trust Commercial |
$3,253.80
|
| Rate for Payer: WPS Commercial |
$4,381.98
|
|
|
DISPOSABLE OVERTUBE BX00711146
|
Facility
OP
|
$2,567.00
|
|
| Hospital Charge Code |
2973602
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$718.76 |
| Max. Negotiated Rate |
$10,268.00 |
| Rate for Payer: Aetna Commercial |
$2,310.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,207.62
|
| Rate for Payer: Aetna Managed Medicare |
$718.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,668.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,232.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,360.51
|
| Rate for Payer: Cash Price |
$770.10
|
| Rate for Payer: Cigna Commercial |
$2,361.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,436.49
|
| Rate for Payer: Health EOS Commercial |
$2,284.63
|
| Rate for Payer: HFN Commercial |
$2,361.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,925.25
|
| Rate for Payer: Multiplan Commercial |
$2,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,540.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,361.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,257.83
|
| Rate for Payer: Quartz Commercial |
$1,668.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,540.20
|
| Rate for Payer: The Alliance Commercial |
$10,268.00
|
| Rate for Payer: WEA Trust Commercial |
$1,411.85
|
| Rate for Payer: WPS Commercial |
$1,901.38
|
|
|
DISPOSABLE OVERTUBE BX00711146
|
Facility
IP
|
$2,567.00
|
|
| Hospital Charge Code |
2973602
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,257.83 |
| Max. Negotiated Rate |
$2,361.64 |
| Rate for Payer: Aetna Commercial |
$2,310.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,360.51
|
| Rate for Payer: Cash Price |
$770.10
|
| Rate for Payer: Cigna Commercial |
$2,361.64
|
| Rate for Payer: Health EOS Commercial |
$2,284.63
|
| Rate for Payer: HFN Commercial |
$2,361.64
|
| Rate for Payer: Multiplan Commercial |
$2,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,540.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,361.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,257.83
|
| Rate for Payer: Quartz Commercial |
$1,540.20
|
| Rate for Payer: WEA Trust Commercial |
$1,411.85
|
| Rate for Payer: WPS Commercial |
$1,901.38
|
|
|
DISSECTOR 3.0MM SMALL JOINT ARTHREX AR-9300DS
|
Facility
IP
|
$959.00
|
|
| Hospital Charge Code |
5348977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
DISSECTOR 3.0MM SMALL JOINT ARTHREX AR-9300DS
|
Facility
OP
|
$959.00
|
|
| Hospital Charge Code |
5348977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
DISSECTOR 3.5MM ARTHROSCOPY ARTHREX AR-8350DS
|
Facility
OP
|
$959.00
|
|
| Hospital Charge Code |
5206674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
DISSECTOR 3.5MM ARTHROSCOPY ARTHREX AR-8350DS
|
Facility
IP
|
$959.00
|
|
| Hospital Charge Code |
5206674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
DISSECTOR 3.5MM CURVED AR-8350CDS
|
Facility
IP
|
$1,616.00
|
|
| Hospital Charge Code |
5414904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.84 |
| Max. Negotiated Rate |
$1,486.72 |
| Rate for Payer: Aetna Commercial |
$1,454.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.48
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: Health EOS Commercial |
$1,438.24
|
| Rate for Payer: HFN Commercial |
$1,486.72
|
| Rate for Payer: Multiplan Commercial |
$1,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$791.84
|
| Rate for Payer: Quartz Commercial |
$969.60
|
| Rate for Payer: WEA Trust Commercial |
$888.80
|
| Rate for Payer: WPS Commercial |
$1,196.97
|
|
|
DISSECTOR 3.5MM CURVED AR-8350CDS
|
Facility
OP
|
$1,616.00
|
|
| Hospital Charge Code |
5414904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.48 |
| Max. Negotiated Rate |
$6,464.00 |
| Rate for Payer: Aetna Commercial |
$1,454.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.76
|
| Rate for Payer: Aetna Managed Medicare |
$452.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,050.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$808.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.48
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$904.31
|
| Rate for Payer: Health EOS Commercial |
$1,438.24
|
| Rate for Payer: HFN Commercial |
$1,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,212.00
|
| Rate for Payer: Multiplan Commercial |
$1,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$791.84
|
| Rate for Payer: Quartz Commercial |
$1,050.40
|
| Rate for Payer: Quartz Medicare Advantage |
$969.60
|
| Rate for Payer: The Alliance Commercial |
$6,464.00
|
| Rate for Payer: WEA Trust Commercial |
$888.80
|
| Rate for Payer: WPS Commercial |
$1,196.97
|
|
|
DISSECTOR 3.5MM SMALL JOINT ARTHREX AR-9350DS
|
Facility
IP
|
$959.00
|
|
| Hospital Charge Code |
5348978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
