|
Flexor 7Fr 45cm ANL3
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 7Fr 45cm ANL3
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.38
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$200.30
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$200.30
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 7Fr 45cm ANL3
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 8Fr 45cm ANL0
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 8Fr 45cm ANL0
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 8Fr 45cm ANL0
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.38
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$200.30
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$200.30
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 8Fr 45cm ANL1
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 8Fr 45cm ANL1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.38
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$200.30
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$200.30
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Flexor 8Fr 45cm ANL1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
FLEX TOE SWANSON LATERAL 4260070
|
Facility
|
OP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
6181325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$6,582.78 |
| Rate for Payer: Aetna Commercial |
$6,439.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,153.47
|
| Rate for Payer: Aetna Managed Medicare |
$2,003.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,650.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,577.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,434.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,792.26
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,582.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,004.16
|
| Rate for Payer: Health EOS Commercial |
$6,368.13
|
| Rate for Payer: HFN Commercial |
$6,582.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,366.40
|
| Rate for Payer: Multiplan Commercial |
$5,724.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,293.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,582.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,506.05
|
| Rate for Payer: Quartz Commercial |
$4,650.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,293.12
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$3,935.36
|
| Rate for Payer: WPS Commercial |
$5,299.66
|
|
|
FLEX TOE SWANSON LATERAL 4260070
|
Facility
|
IP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
6181325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,506.05 |
| Max. Negotiated Rate |
$6,582.78 |
| Rate for Payer: Aetna Commercial |
$6,439.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,153.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,792.26
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,582.78
|
| Rate for Payer: Health EOS Commercial |
$6,368.13
|
| Rate for Payer: HFN Commercial |
$6,582.78
|
| Rate for Payer: Multiplan Commercial |
$5,724.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,582.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,506.05
|
| Rate for Payer: Quartz Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$3,935.36
|
| Rate for Payer: WPS Commercial |
$5,299.66
|
|
|
FLEXTOME BALLOON 2.5 X 15 CBM325015
|
Facility
|
IP
|
$8,695.00
|
|
| Hospital Charge Code |
3072557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,430.97 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,425.68
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
FLEXTOME BALLOON 2.5 X 15 CBM325015
|
Facility
|
OP
|
$8,695.00
|
|
| Hospital Charge Code |
3072557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,531.98 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,877.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,521.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,340.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,060.49
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,782.10
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,425.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,877.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,425.68
|
| Rate for Payer: The Alliance Commercial |
$4,521.40
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
FLEXTOME BALLOON 4.0 X 10 CBM340010
|
Facility
|
OP
|
$8,695.00
|
|
| Hospital Charge Code |
3072556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,531.98 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,877.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,521.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,340.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,060.49
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,782.10
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,425.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,877.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,425.68
|
| Rate for Payer: The Alliance Commercial |
$4,521.40
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
FLEXTOME BALLOON 4.0 X 10 CBM340010
|
Facility
|
IP
|
$8,695.00
|
|
| Hospital Charge Code |
3072556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,430.97 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,425.68
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
FLEXTOME BALLOON 4.0 X 15 CBM340015
|
Facility
|
OP
|
$8,695.00
|
|
| Hospital Charge Code |
3072558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,531.98 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,877.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,521.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,340.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,060.49
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,782.10
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,425.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,877.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,425.68
|
| Rate for Payer: The Alliance Commercial |
$4,521.40
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
FLEXTOME BALLOON 4.0 X 15 CBM340015
|
Facility
|
IP
|
$8,695.00
|
|
| Hospital Charge Code |
3072558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,430.97 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,425.68
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
FLIP CUTTER II 10.0MM AR-1204AF-100
|
Facility
|
OP
|
$5,894.00
|
|
| Hospital Charge Code |
2964677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,716.33 |
| Max. Negotiated Rate |
$5,639.38 |
| Rate for Payer: Aetna Commercial |
$5,516.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,271.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,716.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,984.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,064.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,942.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.77
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,639.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,430.31
|
| Rate for Payer: Health EOS Commercial |
$5,455.49
|
| Rate for Payer: HFN Commercial |
$5,639.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,597.32
|
| Rate for Payer: Multiplan Commercial |
$4,903.81
|
| Rate for Payer: NAPHCARE Commercial |
$3,677.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,639.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.58
|
| Rate for Payer: Quartz Commercial |
$3,984.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,677.86
|
| Rate for Payer: The Alliance Commercial |
$3,064.88
|
| Rate for Payer: WEA Trust Commercial |
$3,371.37
|
| Rate for Payer: WPS Commercial |
$4,540.15
|
|
|
FLIP CUTTER II 10.0MM AR-1204AF-100
|
Facility
|
IP
|
$5,894.00
|
|
| Hospital Charge Code |
2964677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,003.58 |
| Max. Negotiated Rate |
$5,639.38 |
| Rate for Payer: Aetna Commercial |
$5,516.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,271.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.77
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,639.38
|
| Rate for Payer: Health EOS Commercial |
$5,455.49
|
| Rate for Payer: HFN Commercial |
$5,639.38
|
| Rate for Payer: Multiplan Commercial |
$4,903.81
|
| Rate for Payer: Preferred Network Access Commercial |
$5,639.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.58
|
| Rate for Payer: Quartz Commercial |
$3,677.86
|
| Rate for Payer: WEA Trust Commercial |
$3,371.37
|
| Rate for Payer: WPS Commercial |
$4,540.15
|
|
|
FLIP CUTTER II 10.0MM SHORT AR-1204AS-100
|
Facility
|
IP
|
$3,458.00
|
|
| Hospital Charge Code |
5200643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,762.20 |
| Max. Negotiated Rate |
$3,308.61 |
| Rate for Payer: Aetna Commercial |
$3,236.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,092.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,906.05
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,308.61
|
| Rate for Payer: Health EOS Commercial |
$3,200.72
|
| Rate for Payer: HFN Commercial |
$3,308.61
|
| Rate for Payer: Multiplan Commercial |
$2,877.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,308.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,762.20
|
| Rate for Payer: Quartz Commercial |
$2,157.79
|
| Rate for Payer: WEA Trust Commercial |
$1,977.98
|
| Rate for Payer: WPS Commercial |
$2,663.70
|
|
|
FLIP CUTTER II 10.0MM SHORT AR-1204AS-100
|
Facility
|
OP
|
$3,458.00
|
|
| Hospital Charge Code |
5200643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.97 |
| Max. Negotiated Rate |
$3,308.61 |
| Rate for Payer: Aetna Commercial |
$3,236.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,092.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,006.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,337.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,798.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,726.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,906.05
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,308.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,012.56
|
| Rate for Payer: Health EOS Commercial |
$3,200.72
|
| Rate for Payer: HFN Commercial |
$3,308.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,697.24
|
| Rate for Payer: Multiplan Commercial |
$2,877.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,157.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,308.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,762.20
|
| Rate for Payer: Quartz Commercial |
$2,337.61
|
| Rate for Payer: Quartz Medicare Advantage |
$2,157.79
|
| Rate for Payer: The Alliance Commercial |
$1,798.16
|
| Rate for Payer: WEA Trust Commercial |
$1,977.98
|
| Rate for Payer: WPS Commercial |
$2,663.70
|
|
|
FLIP CUTTER II 11.0MM AR-1204AF-110
|
Facility
|
OP
|
$5,145.00
|
|
| Hospital Charge Code |
3901342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,498.22 |
| Max. Negotiated Rate |
$4,922.74 |
| Rate for Payer: Aetna Commercial |
$4,815.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,601.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,498.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,478.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,675.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,568.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,835.92
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Cigna Commercial |
$4,922.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,994.39
|
| Rate for Payer: Health EOS Commercial |
$4,762.21
|
| Rate for Payer: HFN Commercial |
$4,922.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,013.10
|
| Rate for Payer: Multiplan Commercial |
$4,280.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,210.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,922.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,621.89
|
| Rate for Payer: Quartz Commercial |
$3,478.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,210.48
|
| Rate for Payer: The Alliance Commercial |
$2,675.40
|
| Rate for Payer: WEA Trust Commercial |
$2,942.94
|
| Rate for Payer: WPS Commercial |
$3,963.19
|
|
|
FLIP CUTTER II 11.0MM AR-1204AF-110
|
Facility
|
IP
|
$5,145.00
|
|
| Hospital Charge Code |
3901342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,621.89 |
| Max. Negotiated Rate |
$4,922.74 |
| Rate for Payer: Aetna Commercial |
$4,815.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,601.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,835.92
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Cigna Commercial |
$4,922.74
|
| Rate for Payer: Health EOS Commercial |
$4,762.21
|
| Rate for Payer: HFN Commercial |
$4,922.74
|
| Rate for Payer: Multiplan Commercial |
$4,280.64
|
| Rate for Payer: Preferred Network Access Commercial |
$4,922.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,621.89
|
| Rate for Payer: Quartz Commercial |
$3,210.48
|
| Rate for Payer: WEA Trust Commercial |
$2,942.94
|
| Rate for Payer: WPS Commercial |
$3,963.19
|
|
|
FLIP CUTTER II 9.5MM AR-1204AF-95
|
Facility
|
OP
|
$5,453.00
|
|
| Hospital Charge Code |
5306773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,587.91 |
| Max. Negotiated Rate |
$5,217.43 |
| Rate for Payer: Aetna Commercial |
$5,104.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,877.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,587.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,686.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,835.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,722.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,005.69
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,217.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,173.65
|
| Rate for Payer: Health EOS Commercial |
$5,047.30
|
| Rate for Payer: HFN Commercial |
$5,217.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,253.34
|
| Rate for Payer: Multiplan Commercial |
$4,536.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,402.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,778.85
|
| Rate for Payer: Quartz Commercial |
$3,686.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,402.67
|
| Rate for Payer: The Alliance Commercial |
$2,835.56
|
| Rate for Payer: WEA Trust Commercial |
$3,119.12
|
| Rate for Payer: WPS Commercial |
$4,200.45
|
|
|
FLIP CUTTER II 9.5MM AR-1204AF-95
|
Facility
|
IP
|
$5,453.00
|
|
| Hospital Charge Code |
5306773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,778.85 |
| Max. Negotiated Rate |
$5,217.43 |
| Rate for Payer: Aetna Commercial |
$5,104.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,877.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,005.69
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,217.43
|
| Rate for Payer: Health EOS Commercial |
$5,047.30
|
| Rate for Payer: HFN Commercial |
$5,217.43
|
| Rate for Payer: Multiplan Commercial |
$4,536.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,778.85
|
| Rate for Payer: Quartz Commercial |
$3,402.67
|
| Rate for Payer: WEA Trust Commercial |
$3,119.12
|
| Rate for Payer: WPS Commercial |
$4,200.45
|
|
