|
LASER FIBER HOLMIUM 365 OPTILITE SINGLE USE HLF-S365-SMA
|
Facility
|
IP
|
$7,875.00
|
|
| Hospital Charge Code |
3211473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,858.75 |
| Max. Negotiated Rate |
$7,245.00 |
| Rate for Payer: Aetna Commercial |
$7,087.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,772.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,173.75
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna Commercial |
$7,245.00
|
| Rate for Payer: Health EOS Commercial |
$7,008.75
|
| Rate for Payer: HFN Commercial |
$7,245.00
|
| Rate for Payer: Multiplan Commercial |
$6,300.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,245.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,858.75
|
| Rate for Payer: Quartz Commercial |
$4,725.00
|
| Rate for Payer: WEA Trust Commercial |
$4,331.25
|
| Rate for Payer: WPS Commercial |
$5,833.01
|
|
|
LASER FIBER HOLMIUM 365 OPTILITE SINGLE USE HLF-S365-SMA
|
Facility
|
OP
|
$7,875.00
|
|
| Hospital Charge Code |
3211473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$31,500.00 |
| Rate for Payer: Aetna Commercial |
$7,087.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,772.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,205.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,118.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,780.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,173.75
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna Commercial |
$7,245.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,406.85
|
| Rate for Payer: Health EOS Commercial |
$7,008.75
|
| Rate for Payer: HFN Commercial |
$7,245.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,906.25
|
| Rate for Payer: Multiplan Commercial |
$6,300.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,245.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,858.75
|
| Rate for Payer: Quartz Commercial |
$5,118.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,725.00
|
| Rate for Payer: The Alliance Commercial |
$31,500.00
|
| Rate for Payer: WEA Trust Commercial |
$4,331.25
|
| Rate for Payer: WPS Commercial |
$5,833.01
|
|
|
LASER FIBER HOLMIUM 550 OPITLITE SINGLE USE HLF-S550-SMA
|
Facility
|
OP
|
$4,650.00
|
|
| Hospital Charge Code |
3211476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,302.00 |
| Max. Negotiated Rate |
$18,600.00 |
| Rate for Payer: Aetna Commercial |
$4,185.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,999.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,022.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,232.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.50
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,602.14
|
| Rate for Payer: Health EOS Commercial |
$4,138.50
|
| Rate for Payer: HFN Commercial |
$4,278.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,487.50
|
| Rate for Payer: Multiplan Commercial |
$3,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,278.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.50
|
| Rate for Payer: Quartz Commercial |
$3,022.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,790.00
|
| Rate for Payer: The Alliance Commercial |
$18,600.00
|
| Rate for Payer: WEA Trust Commercial |
$2,557.50
|
| Rate for Payer: WPS Commercial |
$3,444.26
|
|
|
LASER FIBER HOLMIUM 550 OPITLITE SINGLE USE HLF-S550-SMA
|
Facility
|
IP
|
$4,650.00
|
|
| Hospital Charge Code |
3211476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,278.50 |
| Max. Negotiated Rate |
$4,278.00 |
| Rate for Payer: Aetna Commercial |
$4,185.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,999.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.50
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,278.00
|
| Rate for Payer: Health EOS Commercial |
$4,138.50
|
| Rate for Payer: HFN Commercial |
$4,278.00
|
| Rate for Payer: Multiplan Commercial |
$3,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,278.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.50
|
| Rate for Payer: Quartz Commercial |
$2,790.00
|
| Rate for Payer: WEA Trust Commercial |
$2,557.50
|
| Rate for Payer: WPS Commercial |
$3,444.26
|
|
|
LASER FIBER HOLMIUM 940 OPTILITE SINGLE USE HLF-S940-SMA
|
Facility
|
IP
|
$5,775.00
|
|
| Hospital Charge Code |
3211480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,829.75 |
| Max. Negotiated Rate |
$5,313.00 |
| Rate for Payer: Aetna Commercial |
$5,197.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,966.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,060.75
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cigna Commercial |
$5,313.00
|
| Rate for Payer: Health EOS Commercial |
$5,139.75
|
| Rate for Payer: HFN Commercial |
$5,313.00
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,465.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,313.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,829.75
|
| Rate for Payer: Quartz Commercial |
$3,465.00
|
| Rate for Payer: WEA Trust Commercial |
$3,176.25
|
| Rate for Payer: WPS Commercial |
$4,277.54
|
|
|
LASER FIBER HOLMIUM 940 OPTILITE SINGLE USE HLF-S940-SMA
|
Facility
|
OP
|
$5,775.00
|
|
| Hospital Charge Code |
3211480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,617.00 |
| Max. Negotiated Rate |
$23,100.00 |
| Rate for Payer: Aetna Commercial |
$5,197.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,966.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,617.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,753.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,772.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,060.75
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cigna Commercial |
$5,313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,231.69
|
| Rate for Payer: Health EOS Commercial |
$5,139.75
|
| Rate for Payer: HFN Commercial |
$5,313.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,331.25
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,465.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,313.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,829.75
|
| Rate for Payer: Quartz Commercial |
$3,753.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,465.00
|
| Rate for Payer: The Alliance Commercial |
$23,100.00
|
| Rate for Payer: WEA Trust Commercial |
$3,176.25
|
| Rate for Payer: WPS Commercial |
$4,277.54
|
|
|
LASER FIBER HOLMIUM FORTEC SU-200 11739
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6207066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$7,604.00 |
| Rate for Payer: Aetna Commercial |
$1,710.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.86
|
| Rate for Payer: Aetna Managed Medicare |
$532.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,235.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$950.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$912.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.53
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,748.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.80
|
| Rate for Payer: Health EOS Commercial |
$1,691.89
|
| Rate for Payer: HFN Commercial |
$1,748.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,425.75
|
| Rate for Payer: Multiplan Commercial |
$1,520.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.92
|
| Rate for Payer: Quartz Beloit One Network |
$931.49
|
| Rate for Payer: Quartz Commercial |
$1,235.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,140.60
|
| Rate for Payer: The Alliance Commercial |
$7,604.00
|
| Rate for Payer: WEA Trust Commercial |
$1,045.55
|
| Rate for Payer: WPS Commercial |
$1,408.07
|
|
|
LASER FIBER HOLMIUM FORTEC SU-200 11739
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6207066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.49 |
| Max. Negotiated Rate |
$1,748.92 |
| Rate for Payer: Aetna Commercial |
$1,710.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.53
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,748.92
|
| Rate for Payer: Health EOS Commercial |
$1,691.89
|
| Rate for Payer: HFN Commercial |
$1,748.92
|
| Rate for Payer: Multiplan Commercial |
$1,520.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.92
|
| Rate for Payer: Quartz Beloit One Network |
$931.49
|
| Rate for Payer: Quartz Commercial |
$1,140.60
|
| Rate for Payer: WEA Trust Commercial |
$1,045.55
|
| Rate for Payer: WPS Commercial |
$1,408.07
|
|
|
LASER FIBER IMPERIUM 300 OMNIGUIDE 10987
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5563643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,932.16 |
| Max. Negotiated Rate |
$5,505.28 |
| Rate for Payer: Aetna Commercial |
$5,385.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,146.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.52
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,505.28
|
| Rate for Payer: Health EOS Commercial |
$5,325.76
|
| Rate for Payer: HFN Commercial |
$5,505.28
|
| Rate for Payer: Multiplan Commercial |
$4,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.16
|
| Rate for Payer: Quartz Commercial |
$3,590.40
|
| Rate for Payer: WEA Trust Commercial |
$3,291.20
|
| Rate for Payer: WPS Commercial |
$4,432.35
|
|
|
LASER FIBER IMPERIUM 300 OMNIGUIDE 10987
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5563643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,675.52 |
| Max. Negotiated Rate |
$23,936.00 |
| Rate for Payer: Aetna Commercial |
$5,385.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,146.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,889.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,992.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.52
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,505.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,348.65
|
| Rate for Payer: Health EOS Commercial |
$5,325.76
|
| Rate for Payer: HFN Commercial |
$5,505.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,488.00
|
| Rate for Payer: Multiplan Commercial |
$4,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.16
|
| Rate for Payer: Quartz Commercial |
$3,889.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,590.40
|
| Rate for Payer: The Alliance Commercial |
$23,936.00
|
| Rate for Payer: WEA Trust Commercial |
$3,291.20
|
| Rate for Payer: WPS Commercial |
$4,432.35
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-1000-QRT 11809
|
Facility
|
OP
|
$2,780.00
|
|
| Hospital Charge Code |
6199028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$778.40 |
| Max. Negotiated Rate |
$11,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,390.80
|
| Rate for Payer: Aetna Managed Medicare |
$778.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.40
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,557.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,555.69
|
| Rate for Payer: Health EOS Commercial |
$2,474.20
|
| Rate for Payer: HFN Commercial |
$2,557.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.00
|
| Rate for Payer: Multiplan Commercial |
$2,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,557.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.20
|
| Rate for Payer: Quartz Commercial |
$1,807.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.00
|
| Rate for Payer: The Alliance Commercial |
$11,120.00
|
| Rate for Payer: WEA Trust Commercial |
$1,529.00
|
| Rate for Payer: WPS Commercial |
$2,059.15
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-1000-QRT 11809
|
Facility
|
IP
|
$2,780.00
|
|
| Hospital Charge Code |
6199028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,362.20 |
| Max. Negotiated Rate |
$2,557.60 |
| Rate for Payer: Aetna Commercial |
$2,502.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,390.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.40
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,557.60
|
| Rate for Payer: Health EOS Commercial |
$2,474.20
|
| Rate for Payer: HFN Commercial |
$2,557.60
|
| Rate for Payer: Multiplan Commercial |
$2,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,557.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.20
|
| Rate for Payer: Quartz Commercial |
$1,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,529.00
|
| Rate for Payer: WPS Commercial |
$2,059.15
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-200-QRT 11797
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6188973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.49 |
| Max. Negotiated Rate |
$1,748.92 |
| Rate for Payer: Aetna Commercial |
$1,710.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.53
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,748.92
|
| Rate for Payer: Health EOS Commercial |
$1,691.89
|
| Rate for Payer: HFN Commercial |
$1,748.92
|
| Rate for Payer: Multiplan Commercial |
$1,520.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.92
|
| Rate for Payer: Quartz Beloit One Network |
$931.49
|
| Rate for Payer: Quartz Commercial |
$1,140.60
|
| Rate for Payer: WEA Trust Commercial |
$1,045.55
|
| Rate for Payer: WPS Commercial |
$1,408.07
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-200-QRT 11797
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6188973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$7,604.00 |
| Rate for Payer: Aetna Commercial |
$1,710.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.86
|
| Rate for Payer: Aetna Managed Medicare |
$532.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,235.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$950.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$912.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.53
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,748.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.80
|
| Rate for Payer: Health EOS Commercial |
$1,691.89
|
| Rate for Payer: HFN Commercial |
$1,748.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,425.75
|
| Rate for Payer: Multiplan Commercial |
$1,520.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.92
|
| Rate for Payer: Quartz Beloit One Network |
$931.49
|
| Rate for Payer: Quartz Commercial |
$1,235.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,140.60
|
| Rate for Payer: The Alliance Commercial |
$7,604.00
|
| Rate for Payer: WEA Trust Commercial |
$1,045.55
|
| Rate for Payer: WPS Commercial |
$1,408.07
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 1000 11048
|
Facility
|
IP
|
$2,891.00
|
|
| Hospital Charge Code |
6153680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,416.59 |
| Max. Negotiated Rate |
$2,659.72 |
| Rate for Payer: Aetna Commercial |
$2,601.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.23
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,659.72
|
| Rate for Payer: Health EOS Commercial |
$2,572.99
|
| Rate for Payer: HFN Commercial |
$2,659.72
|
| Rate for Payer: Multiplan Commercial |
$2,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.59
|
| Rate for Payer: Quartz Commercial |
$1,734.60
|
| Rate for Payer: WEA Trust Commercial |
$1,590.05
|
| Rate for Payer: WPS Commercial |
$2,141.36
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 1000 11048
|
Facility
|
OP
|
$2,891.00
|
|
| Hospital Charge Code |
6153680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$809.48 |
| Max. Negotiated Rate |
$11,564.00 |
| Rate for Payer: Aetna Commercial |
$2,601.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.26
|
| Rate for Payer: Aetna Managed Medicare |
$809.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,879.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.23
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,659.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,617.80
|
| Rate for Payer: Health EOS Commercial |
$2,572.99
|
| Rate for Payer: HFN Commercial |
$2,659.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,168.25
|
| Rate for Payer: Multiplan Commercial |
$2,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.59
|
| Rate for Payer: Quartz Commercial |
$1,879.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,734.60
|
| Rate for Payer: The Alliance Commercial |
$11,564.00
|
| Rate for Payer: WEA Trust Commercial |
$1,590.05
|
| Rate for Payer: WPS Commercial |
$2,141.36
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 200 11045
|
Facility
|
IP
|
$1,977.00
|
|
| Hospital Charge Code |
6166519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.73 |
| Max. Negotiated Rate |
$1,818.84 |
| Rate for Payer: Aetna Commercial |
$1,779.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.81
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,818.84
|
| Rate for Payer: Health EOS Commercial |
$1,759.53
|
| Rate for Payer: HFN Commercial |
$1,818.84
|
| Rate for Payer: Multiplan Commercial |
$1,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.84
|
| Rate for Payer: Quartz Beloit One Network |
$968.73
|
| Rate for Payer: Quartz Commercial |
$1,186.20
|
| Rate for Payer: WEA Trust Commercial |
$1,087.35
|
| Rate for Payer: WPS Commercial |
$1,464.36
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 200 11045
|
Facility
|
OP
|
$1,977.00
|
|
| Hospital Charge Code |
6166519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.56 |
| Max. Negotiated Rate |
$7,908.00 |
| Rate for Payer: Aetna Commercial |
$1,779.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.22
|
| Rate for Payer: Aetna Managed Medicare |
$553.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,285.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.81
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,818.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,106.33
|
| Rate for Payer: Health EOS Commercial |
$1,759.53
|
| Rate for Payer: HFN Commercial |
$1,818.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.75
|
| Rate for Payer: Multiplan Commercial |
$1,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.84
|
| Rate for Payer: Quartz Beloit One Network |
$968.73
|
| Rate for Payer: Quartz Commercial |
$1,285.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,186.20
|
| Rate for Payer: The Alliance Commercial |
$7,908.00
|
| Rate for Payer: WEA Trust Commercial |
$1,087.35
|
| Rate for Payer: WPS Commercial |
$1,464.36
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 272 11049
|
Facility
|
OP
|
$3,074.00
|
|
| Hospital Charge Code |
6217153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.72 |
| Max. Negotiated Rate |
$12,296.00 |
| Rate for Payer: Aetna Commercial |
$2,766.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,643.64
|
| Rate for Payer: Aetna Managed Medicare |
$860.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,998.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,475.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,629.22
|
| Rate for Payer: Cash Price |
$922.20
|
| Rate for Payer: Cigna Commercial |
$2,828.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,720.21
|
| Rate for Payer: Health EOS Commercial |
$2,735.86
|
| Rate for Payer: HFN Commercial |
$2,828.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,305.50
|
| Rate for Payer: Multiplan Commercial |
$2,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,844.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,828.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,506.26
|
| Rate for Payer: Quartz Commercial |
$1,998.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,844.40
|
| Rate for Payer: The Alliance Commercial |
$12,296.00
|
| Rate for Payer: WEA Trust Commercial |
$1,690.70
|
| Rate for Payer: WPS Commercial |
$2,276.91
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 272 11049
|
Facility
|
IP
|
$3,074.00
|
|
| Hospital Charge Code |
6217153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,506.26 |
| Max. Negotiated Rate |
$2,828.08 |
| Rate for Payer: Aetna Commercial |
$2,766.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,643.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,629.22
|
| Rate for Payer: Cash Price |
$922.20
|
| Rate for Payer: Cigna Commercial |
$2,828.08
|
| Rate for Payer: Health EOS Commercial |
$2,735.86
|
| Rate for Payer: HFN Commercial |
$2,828.08
|
| Rate for Payer: Multiplan Commercial |
$2,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,844.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,828.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,506.26
|
| Rate for Payer: Quartz Commercial |
$1,844.40
|
| Rate for Payer: WEA Trust Commercial |
$1,690.70
|
| Rate for Payer: WPS Commercial |
$2,276.91
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 365 FORTEC 11046
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6167650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.49 |
| Max. Negotiated Rate |
$1,748.92 |
| Rate for Payer: Aetna Commercial |
$1,710.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.53
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,748.92
|
| Rate for Payer: Health EOS Commercial |
$1,691.89
|
| Rate for Payer: HFN Commercial |
$1,748.92
|
| Rate for Payer: Multiplan Commercial |
$1,520.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.92
|
| Rate for Payer: Quartz Beloit One Network |
$931.49
|
| Rate for Payer: Quartz Commercial |
$1,140.60
|
| Rate for Payer: WEA Trust Commercial |
$1,045.55
|
| Rate for Payer: WPS Commercial |
$1,408.07
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 365 FORTEC 11046
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6167650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$7,604.00 |
| Rate for Payer: Aetna Commercial |
$1,710.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.86
|
| Rate for Payer: Aetna Managed Medicare |
$532.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,235.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$950.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$912.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.53
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,748.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.80
|
| Rate for Payer: Health EOS Commercial |
$1,691.89
|
| Rate for Payer: HFN Commercial |
$1,748.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,425.75
|
| Rate for Payer: Multiplan Commercial |
$1,520.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.92
|
| Rate for Payer: Quartz Beloit One Network |
$931.49
|
| Rate for Payer: Quartz Commercial |
$1,235.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,140.60
|
| Rate for Payer: The Alliance Commercial |
$7,604.00
|
| Rate for Payer: WEA Trust Commercial |
$1,045.55
|
| Rate for Payer: WPS Commercial |
$1,408.07
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 550 11047
|
Facility
|
IP
|
$2,184.00
|
|
| Hospital Charge Code |
6153681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,070.16 |
| Max. Negotiated Rate |
$2,009.28 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,310.40
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.69
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 550 11047
|
Facility
|
OP
|
$2,184.00
|
|
| Hospital Charge Code |
6153681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$8,736.00 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Aetna Managed Medicare |
$611.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,419.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,048.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,222.17
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,419.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,310.40
|
| Rate for Payer: The Alliance Commercial |
$8,736.00
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.69
|
|
|
LASER FIBER MOSES 200 AC-10030100
|
Facility
|
IP
|
$4,456.25
|
|
| Hospital Charge Code |
6248126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,183.56 |
| Max. Negotiated Rate |
$4,099.75 |
| Rate for Payer: Aetna Commercial |
$4,010.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,832.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,361.81
|
| Rate for Payer: Cash Price |
$1,336.88
|
| Rate for Payer: Cigna Commercial |
$4,099.75
|
| Rate for Payer: Health EOS Commercial |
$3,966.06
|
| Rate for Payer: HFN Commercial |
$4,099.75
|
| Rate for Payer: Multiplan Commercial |
$3,565.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,673.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,099.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,183.56
|
| Rate for Payer: Quartz Commercial |
$2,673.75
|
| Rate for Payer: WEA Trust Commercial |
$2,450.94
|
| Rate for Payer: WPS Commercial |
$3,300.74
|
|
