|
LASER FIBER FLEXIVA PULSE 910 M006L8405940
|
Facility
|
IP
|
$6,220.00
|
|
| Hospital Charge Code |
4595196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,169.71 |
| Max. Negotiated Rate |
$5,951.30 |
| Rate for Payer: Aetna Commercial |
$5,821.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,563.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,428.46
|
| Rate for Payer: Cash Price |
$1,866.00
|
| Rate for Payer: Cigna Commercial |
$5,951.30
|
| Rate for Payer: Health EOS Commercial |
$5,757.23
|
| Rate for Payer: HFN Commercial |
$5,951.30
|
| Rate for Payer: Multiplan Commercial |
$5,175.04
|
| Rate for Payer: Preferred Network Access Commercial |
$5,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,169.71
|
| Rate for Payer: Quartz Commercial |
$3,881.28
|
| Rate for Payer: WEA Trust Commercial |
$3,557.84
|
| Rate for Payer: WPS Commercial |
$4,791.27
|
|
|
LASER FIBER FLEXIVA PULSE 910 M006L8405940
|
Facility
|
OP
|
$6,220.00
|
|
| Hospital Charge Code |
4595196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,811.26 |
| Max. Negotiated Rate |
$5,951.30 |
| Rate for Payer: Aetna Commercial |
$5,821.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,563.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,204.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,234.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,105.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,428.46
|
| Rate for Payer: Cash Price |
$1,866.00
|
| Rate for Payer: Cigna Commercial |
$5,951.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,620.04
|
| Rate for Payer: Health EOS Commercial |
$5,757.23
|
| Rate for Payer: HFN Commercial |
$5,951.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,851.60
|
| Rate for Payer: Multiplan Commercial |
$5,175.04
|
| Rate for Payer: NAPHCARE Commercial |
$3,881.28
|
| Rate for Payer: Preferred Network Access Commercial |
$5,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,169.71
|
| Rate for Payer: Quartz Commercial |
$4,204.72
|
| Rate for Payer: Quartz Medicare Advantage |
$3,881.28
|
| Rate for Payer: The Alliance Commercial |
$3,234.40
|
| Rate for Payer: WEA Trust Commercial |
$3,557.84
|
| Rate for Payer: WPS Commercial |
$4,791.27
|
|
|
LASER FIBER FLEXIVA TRACTIP 200 MICRON M0068403960/M006L7406960
|
Facility
|
IP
|
$5,442.00
|
|
| Hospital Charge Code |
4595200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,773.24 |
| Max. Negotiated Rate |
$5,206.91 |
| Rate for Payer: Aetna Commercial |
$5,093.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,867.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,999.63
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cigna Commercial |
$5,206.91
|
| Rate for Payer: Health EOS Commercial |
$5,037.12
|
| Rate for Payer: HFN Commercial |
$5,206.91
|
| Rate for Payer: Multiplan Commercial |
$4,527.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,206.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,773.24
|
| Rate for Payer: Quartz Commercial |
$3,395.81
|
| Rate for Payer: WEA Trust Commercial |
$3,112.82
|
| Rate for Payer: WPS Commercial |
$4,191.97
|
|
|
LASER FIBER FLEXIVA TRACTIP 200 MICRON M0068403960/M006L7406960
|
Facility
|
OP
|
$5,442.00
|
|
| Hospital Charge Code |
4595200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,584.71 |
| Max. Negotiated Rate |
$5,206.91 |
| Rate for Payer: Aetna Commercial |
$5,093.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,867.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,584.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,678.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,829.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,716.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,999.63
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cigna Commercial |
$5,206.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,167.24
|
| Rate for Payer: Health EOS Commercial |
$5,037.12
|
| Rate for Payer: HFN Commercial |
$5,206.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,244.76
|
| Rate for Payer: Multiplan Commercial |
$4,527.74
|
| Rate for Payer: NAPHCARE Commercial |
$3,395.81
|
| Rate for Payer: Preferred Network Access Commercial |
$5,206.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,773.24
|
| Rate for Payer: Quartz Commercial |
$3,678.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,395.81
|
| Rate for Payer: The Alliance Commercial |
$2,829.84
|
| Rate for Payer: WEA Trust Commercial |
$3,112.82
|
| Rate for Payer: WPS Commercial |
$4,191.97
|
|
|
LASER FIBER FORTEC HOLMIUM 365 10494
|
Facility
|
OP
|
$1,920.00
|
|
| Hospital Charge Code |
6174515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.10 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Aetna Managed Medicare |
$559.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,297.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.44
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.60
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.08
|
| Rate for Payer: The Alliance Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
LASER FIBER FORTEC HOLMIUM 365 10494
|
Facility
|
IP
|
$1,920.00
|
|
| Hospital Charge Code |
6174515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,198.08
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
LASER FIBER FORTEC HOLMIUM 550 10495
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6184978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.06 |
| Max. Negotiated Rate |
$2,004.50 |
| Rate for Payer: Aetna Commercial |
$1,960.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.77
|
| Rate for Payer: Aetna Managed Medicare |
$610.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,416.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.76
|
| Rate for Payer: Cash Price |
$628.50
|
| Rate for Payer: Cigna Commercial |
$2,004.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,219.29
|
| Rate for Payer: Health EOS Commercial |
$1,939.13
|
| Rate for Payer: HFN Commercial |
$2,004.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,634.10
|
| Rate for Payer: Multiplan Commercial |
$1,743.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.61
|
| Rate for Payer: Quartz Commercial |
$1,416.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,307.28
|
| Rate for Payer: The Alliance Commercial |
$1,089.40
|
| Rate for Payer: WEA Trust Commercial |
$1,198.34
|
| Rate for Payer: WPS Commercial |
$1,613.78
|
|
|
LASER FIBER FORTEC HOLMIUM 550 10495
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6184978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.61 |
| Max. Negotiated Rate |
$2,004.50 |
| Rate for Payer: Aetna Commercial |
$1,960.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.76
|
| Rate for Payer: Cash Price |
$628.50
|
| Rate for Payer: Cigna Commercial |
$2,004.50
|
| Rate for Payer: Health EOS Commercial |
$1,939.13
|
| Rate for Payer: HFN Commercial |
$2,004.50
|
| Rate for Payer: Multiplan Commercial |
$1,743.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.61
|
| Rate for Payer: Quartz Commercial |
$1,307.28
|
| Rate for Payer: WEA Trust Commercial |
$1,198.34
|
| Rate for Payer: WPS Commercial |
$1,613.78
|
|
|
LASER FIBER GREENLIGHT XPS MoXy 10486
|
Facility
|
IP
|
$6,455.00
|
|
| Hospital Charge Code |
5306930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,289.47 |
| Max. Negotiated Rate |
$6,176.14 |
| Rate for Payer: Aetna Commercial |
$6,041.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,558.00
|
| Rate for Payer: Cash Price |
$1,936.50
|
| Rate for Payer: Cigna Commercial |
$6,176.14
|
| Rate for Payer: Health EOS Commercial |
$5,974.75
|
| Rate for Payer: HFN Commercial |
$6,176.14
|
| Rate for Payer: Multiplan Commercial |
$5,370.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6,176.14
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.47
|
| Rate for Payer: Quartz Commercial |
$4,027.92
|
| Rate for Payer: WEA Trust Commercial |
$3,692.26
|
| Rate for Payer: WPS Commercial |
$4,972.29
|
|
|
LASER FIBER GREENLIGHT XPS MoXy 10486
|
Facility
|
OP
|
$6,455.00
|
|
| Hospital Charge Code |
5306930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,879.70 |
| Max. Negotiated Rate |
$6,176.14 |
| Rate for Payer: Aetna Commercial |
$6,041.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,363.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,356.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,222.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,558.00
|
| Rate for Payer: Cash Price |
$1,936.50
|
| Rate for Payer: Cigna Commercial |
$6,176.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,756.81
|
| Rate for Payer: Health EOS Commercial |
$5,974.75
|
| Rate for Payer: HFN Commercial |
$6,176.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.90
|
| Rate for Payer: Multiplan Commercial |
$5,370.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.92
|
| Rate for Payer: Preferred Network Access Commercial |
$6,176.14
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.47
|
| Rate for Payer: Quartz Commercial |
$4,363.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4,027.92
|
| Rate for Payer: The Alliance Commercial |
$3,356.60
|
| Rate for Payer: WEA Trust Commercial |
$3,692.26
|
| Rate for Payer: WPS Commercial |
$4,972.29
|
|
|
LASER FIBER HOLMIUM 200 FORTEC 10493
|
Facility
|
OP
|
$1,846.00
|
|
| Hospital Charge Code |
5349479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.56 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,247.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$959.92
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
LASER FIBER HOLMIUM 200 FORTEC 10493
|
Facility
|
IP
|
$1,846.00
|
|
| Hospital Charge Code |
5349479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
LASER FIBER HOLMIUM 273 SINGLE USE HLF-S273-SMA
|
Facility
|
OP
|
$4,351.00
|
|
| Hospital Charge Code |
3211469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,267.01 |
| Max. Negotiated Rate |
$4,163.04 |
| Rate for Payer: Aetna Commercial |
$4,072.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,891.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,267.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,941.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,262.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,172.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,398.27
|
| Rate for Payer: Cash Price |
$1,305.30
|
| Rate for Payer: Cigna Commercial |
$4,163.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,532.28
|
| Rate for Payer: Health EOS Commercial |
$4,027.29
|
| Rate for Payer: HFN Commercial |
$4,163.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,393.78
|
| Rate for Payer: Multiplan Commercial |
$3,620.03
|
| Rate for Payer: NAPHCARE Commercial |
$2,715.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,163.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,217.27
|
| Rate for Payer: Quartz Commercial |
$2,941.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,715.02
|
| Rate for Payer: The Alliance Commercial |
$2,262.52
|
| Rate for Payer: WEA Trust Commercial |
$2,488.77
|
| Rate for Payer: WPS Commercial |
$3,351.58
|
|
|
LASER FIBER HOLMIUM 273 SINGLE USE HLF-S273-SMA
|
Facility
|
IP
|
$4,351.00
|
|
| Hospital Charge Code |
3211469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,217.27 |
| Max. Negotiated Rate |
$4,163.04 |
| Rate for Payer: Aetna Commercial |
$4,072.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,891.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,398.27
|
| Rate for Payer: Cash Price |
$1,305.30
|
| Rate for Payer: Cigna Commercial |
$4,163.04
|
| Rate for Payer: Health EOS Commercial |
$4,027.29
|
| Rate for Payer: HFN Commercial |
$4,163.04
|
| Rate for Payer: Multiplan Commercial |
$3,620.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,163.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,217.27
|
| Rate for Payer: Quartz Commercial |
$2,715.02
|
| Rate for Payer: WEA Trust Commercial |
$2,488.77
|
| Rate for Payer: WPS Commercial |
$3,351.58
|
|
|
LASER FIBER HOLMIUM365 FORTEC SU-200-RT 11553
|
Facility
|
IP
|
$1,846.00
|
|
| Hospital Charge Code |
6184991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
LASER FIBER HOLMIUM365 FORTEC SU-200-RT 11553
|
Facility
|
OP
|
$1,846.00
|
|
| Hospital Charge Code |
6184991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.56 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,247.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$959.92
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
LASER FIBER HOLMIUM365 FORTEC SU-365-RT 11559
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6184990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.57 |
| Max. Negotiated Rate |
$1,818.88 |
| Rate for Payer: Aetna Commercial |
$1,779.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.25
|
| Rate for Payer: Aetna Managed Medicare |
$553.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,285.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.83
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,818.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,106.38
|
| Rate for Payer: Health EOS Commercial |
$1,759.57
|
| Rate for Payer: HFN Commercial |
$1,818.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.78
|
| Rate for Payer: Multiplan Commercial |
$1,581.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$968.75
|
| Rate for Payer: Quartz Commercial |
$1,285.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,186.22
|
| Rate for Payer: The Alliance Commercial |
$988.52
|
| Rate for Payer: WEA Trust Commercial |
$1,087.37
|
| Rate for Payer: WPS Commercial |
$1,464.34
|
|
|
LASER FIBER HOLMIUM365 FORTEC SU-365-RT 11559
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6184990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.75 |
| Max. Negotiated Rate |
$1,818.88 |
| Rate for Payer: Aetna Commercial |
$1,779.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.83
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,818.88
|
| Rate for Payer: Health EOS Commercial |
$1,759.57
|
| Rate for Payer: HFN Commercial |
$1,818.88
|
| Rate for Payer: Multiplan Commercial |
$1,581.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$968.75
|
| Rate for Payer: Quartz Commercial |
$1,186.22
|
| Rate for Payer: WEA Trust Commercial |
$1,087.37
|
| Rate for Payer: WPS Commercial |
$1,464.34
|
|
|
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 |
$4,013.10 |
| Max. Negotiated Rate |
$7,534.80 |
| Rate for Payer: Aetna Commercial |
$7,371.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,043.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,340.70
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna Commercial |
$7,534.80
|
| Rate for Payer: Health EOS Commercial |
$7,289.10
|
| Rate for Payer: HFN Commercial |
$7,534.80
|
| Rate for Payer: Multiplan Commercial |
$6,552.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,534.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,013.10
|
| Rate for Payer: Quartz Commercial |
$4,914.00
|
| Rate for Payer: WEA Trust Commercial |
$4,504.50
|
| Rate for Payer: WPS Commercial |
$6,066.11
|
|
|
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 |
$2,293.20 |
| Max. Negotiated Rate |
$7,534.80 |
| Rate for Payer: Aetna Commercial |
$7,371.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,043.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,293.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,323.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,931.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,340.70
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna Commercial |
$7,534.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,583.25
|
| Rate for Payer: Health EOS Commercial |
$7,289.10
|
| Rate for Payer: HFN Commercial |
$7,534.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,142.50
|
| Rate for Payer: Multiplan Commercial |
$6,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,914.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,534.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,013.10
|
| Rate for Payer: Quartz Commercial |
$5,323.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,914.00
|
| Rate for Payer: The Alliance Commercial |
$4,095.00
|
| Rate for Payer: WEA Trust Commercial |
$4,504.50
|
| Rate for Payer: WPS Commercial |
$6,066.11
|
|
|
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 |
$2,369.64 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,581.89
|
|
|
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 |
$1,354.08 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,143.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,321.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,706.30
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,627.00
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$3,143.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,901.60
|
| Rate for Payer: The Alliance Commercial |
$2,418.00
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,581.89
|
|
|
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 |
$1,681.68 |
| Max. Negotiated Rate |
$5,525.52 |
| Rate for Payer: Aetna Commercial |
$5,405.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,165.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,681.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,903.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,003.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,882.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,183.18
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cigna Commercial |
$5,525.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,361.05
|
| Rate for Payer: Health EOS Commercial |
$5,345.34
|
| Rate for Payer: HFN Commercial |
$5,525.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,504.50
|
| Rate for Payer: Multiplan Commercial |
$4,804.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,525.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,942.94
|
| Rate for Payer: Quartz Commercial |
$3,903.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,603.60
|
| Rate for Payer: The Alliance Commercial |
$3,003.00
|
| Rate for Payer: WEA Trust Commercial |
$3,303.30
|
| Rate for Payer: WPS Commercial |
$4,448.48
|
|
|
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 |
$2,942.94 |
| Max. Negotiated Rate |
$5,525.52 |
| Rate for Payer: Aetna Commercial |
$5,405.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,165.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,183.18
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cigna Commercial |
$5,525.52
|
| Rate for Payer: Health EOS Commercial |
$5,345.34
|
| Rate for Payer: HFN Commercial |
$5,525.52
|
| Rate for Payer: Multiplan Commercial |
$4,804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,525.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,942.94
|
| Rate for Payer: Quartz Commercial |
$3,603.60
|
| Rate for Payer: WEA Trust Commercial |
$3,303.30
|
| Rate for Payer: WPS Commercial |
$4,448.48
|
|
|
LASER FIBER HOLMIUM FORTEC SU-200 11739
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6207066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.57 |
| Max. Negotiated Rate |
$1,818.88 |
| Rate for Payer: Aetna Commercial |
$1,779.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.25
|
| Rate for Payer: Aetna Managed Medicare |
$553.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,285.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.83
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,818.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,106.38
|
| Rate for Payer: Health EOS Commercial |
$1,759.57
|
| Rate for Payer: HFN Commercial |
$1,818.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.78
|
| Rate for Payer: Multiplan Commercial |
$1,581.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$968.75
|
| Rate for Payer: Quartz Commercial |
$1,285.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,186.22
|
| Rate for Payer: The Alliance Commercial |
$988.52
|
| Rate for Payer: WEA Trust Commercial |
$1,087.37
|
| Rate for Payer: WPS Commercial |
$1,464.34
|
|
