|
LASER FIBER HOLMIUM FORTEC SU-200 11739
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6207066
|
|
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 IMPERIUM 300 OMNIGUIDE 10987
|
Facility
|
OP
|
$5,984.00
|
|
| Hospital Charge Code |
5563643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,742.54 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.69
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,667.52
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$4,045.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.02
|
| Rate for Payer: The Alliance Commercial |
$3,111.68
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
LASER FIBER IMPERIUM 300 OMNIGUIDE 10987
|
Facility
|
IP
|
$5,984.00
|
|
| Hospital Charge Code |
5563643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,049.45 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$3,734.02
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-1000-QRT 11809
|
Facility
|
IP
|
$2,780.00
|
|
| Hospital Charge Code |
6199028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,416.69 |
| Max. Negotiated Rate |
$2,659.90 |
| Rate for Payer: Aetna Commercial |
$2,602.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.34
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,659.90
|
| Rate for Payer: Health EOS Commercial |
$2,573.17
|
| Rate for Payer: HFN Commercial |
$2,659.90
|
| Rate for Payer: Multiplan Commercial |
$2,312.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.69
|
| Rate for Payer: Quartz Commercial |
$1,734.72
|
| Rate for Payer: WEA Trust Commercial |
$1,590.16
|
| Rate for Payer: WPS Commercial |
$2,141.43
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-1000-QRT 11809
|
Facility
|
OP
|
$2,780.00
|
|
| Hospital Charge Code |
6199028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$809.54 |
| Max. Negotiated Rate |
$2,659.90 |
| Rate for Payer: Aetna Commercial |
$2,602.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.43
|
| Rate for Payer: Aetna Managed Medicare |
$809.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,879.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.34
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,659.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,617.96
|
| Rate for Payer: Health EOS Commercial |
$2,573.17
|
| Rate for Payer: HFN Commercial |
$2,659.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,168.40
|
| Rate for Payer: Multiplan Commercial |
$2,312.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.69
|
| Rate for Payer: Quartz Commercial |
$1,879.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,734.72
|
| Rate for Payer: The Alliance Commercial |
$1,445.60
|
| Rate for Payer: WEA Trust Commercial |
$1,590.16
|
| Rate for Payer: WPS Commercial |
$2,141.43
|
|
|
LASER FIBER MASTERPULSE FORTEC SU-200-QRT 11797
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6188973
|
|
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 MASTERPULSE FORTEC SU-200-QRT 11797
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6188973
|
|
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 MASTERPULSE HOLMIUM 1000 11048
|
Facility
|
OP
|
$2,891.00
|
|
| Hospital Charge Code |
6153680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$841.86 |
| Max. Negotiated Rate |
$2,766.11 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Aetna Managed Medicare |
$841.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,954.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,503.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,443.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,682.56
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,254.98
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,803.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,954.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,803.98
|
| Rate for Payer: The Alliance Commercial |
$1,503.32
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 1000 11048
|
Facility
|
IP
|
$2,891.00
|
|
| Hospital Charge Code |
6153680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,473.25 |
| Max. Negotiated Rate |
$2,766.11 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,803.98
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 200 11045
|
Facility
|
OP
|
$1,977.00
|
|
| Hospital Charge Code |
6166519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.70 |
| Max. Negotiated Rate |
$1,891.59 |
| Rate for Payer: Aetna Commercial |
$1,850.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.23
|
| Rate for Payer: Aetna Managed Medicare |
$575.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,336.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,028.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.72
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,891.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,150.61
|
| Rate for Payer: Health EOS Commercial |
$1,829.91
|
| Rate for Payer: HFN Commercial |
$1,891.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,542.06
|
| Rate for Payer: Multiplan Commercial |
$1,644.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.48
|
| Rate for Payer: Quartz Commercial |
$1,336.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.65
|
| Rate for Payer: The Alliance Commercial |
$1,028.04
|
| Rate for Payer: WEA Trust Commercial |
$1,130.84
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 200 11045
|
Facility
|
IP
|
$1,977.00
|
|
| Hospital Charge Code |
6166519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,007.48 |
| Max. Negotiated Rate |
$1,891.59 |
| Rate for Payer: Aetna Commercial |
$1,850.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.72
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,891.59
|
| Rate for Payer: Health EOS Commercial |
$1,829.91
|
| Rate for Payer: HFN Commercial |
$1,891.59
|
| Rate for Payer: Multiplan Commercial |
$1,644.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.48
|
| Rate for Payer: Quartz Commercial |
$1,233.65
|
| Rate for Payer: WEA Trust Commercial |
$1,130.84
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 272 11049
|
Facility
|
OP
|
$3,074.00
|
|
| Hospital Charge Code |
6217153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$895.15 |
| Max. Negotiated Rate |
$2,941.20 |
| Rate for Payer: Aetna Commercial |
$2,877.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,749.39
|
| Rate for Payer: Aetna Managed Medicare |
$895.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,078.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,598.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,534.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.39
|
| Rate for Payer: Cash Price |
$922.20
|
| Rate for Payer: Cigna Commercial |
$2,941.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,789.07
|
| Rate for Payer: Health EOS Commercial |
$2,845.29
|
| Rate for Payer: HFN Commercial |
$2,941.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,397.72
|
| Rate for Payer: Multiplan Commercial |
$2,557.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,918.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,941.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,566.51
|
| Rate for Payer: Quartz Commercial |
$2,078.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,918.18
|
| Rate for Payer: The Alliance Commercial |
$1,598.48
|
| Rate for Payer: WEA Trust Commercial |
$1,758.33
|
| Rate for Payer: WPS Commercial |
$2,367.90
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 272 11049
|
Facility
|
IP
|
$3,074.00
|
|
| Hospital Charge Code |
6217153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,566.51 |
| Max. Negotiated Rate |
$2,941.20 |
| Rate for Payer: Aetna Commercial |
$2,877.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,749.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.39
|
| Rate for Payer: Cash Price |
$922.20
|
| Rate for Payer: Cigna Commercial |
$2,941.20
|
| Rate for Payer: Health EOS Commercial |
$2,845.29
|
| Rate for Payer: HFN Commercial |
$2,941.20
|
| Rate for Payer: Multiplan Commercial |
$2,557.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,941.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,566.51
|
| Rate for Payer: Quartz Commercial |
$1,918.18
|
| Rate for Payer: WEA Trust Commercial |
$1,758.33
|
| Rate for Payer: WPS Commercial |
$2,367.90
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 365 FORTEC 11046
|
Facility
|
IP
|
$1,901.00
|
|
| Hospital Charge Code |
6167650
|
|
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 MASTERPULSE HOLMIUM 365 FORTEC 11046
|
Facility
|
OP
|
$1,901.00
|
|
| Hospital Charge Code |
6167650
|
|
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 MASTERPULSE HOLMIUM 550 11047
|
Facility
|
IP
|
$2,184.00
|
|
| Hospital Charge Code |
6153681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,112.97 |
| Max. Negotiated Rate |
$2,089.65 |
| Rate for Payer: Aetna Commercial |
$2,044.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,953.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.82
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,089.65
|
| Rate for Payer: Health EOS Commercial |
$2,021.51
|
| Rate for Payer: HFN Commercial |
$2,089.65
|
| Rate for Payer: Multiplan Commercial |
$1,817.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,089.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.97
|
| Rate for Payer: Quartz Commercial |
$1,362.82
|
| Rate for Payer: WEA Trust Commercial |
$1,249.25
|
| Rate for Payer: WPS Commercial |
$1,682.34
|
|
|
LASER FIBER MASTERPULSE HOLMIUM 550 11047
|
Facility
|
OP
|
$2,184.00
|
|
| Hospital Charge Code |
6153681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.98 |
| Max. Negotiated Rate |
$2,089.65 |
| Rate for Payer: Aetna Commercial |
$2,044.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,953.37
|
| Rate for Payer: Aetna Managed Medicare |
$635.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,476.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,135.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,090.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.82
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,089.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,271.09
|
| Rate for Payer: Health EOS Commercial |
$2,021.51
|
| Rate for Payer: HFN Commercial |
$2,089.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,703.52
|
| Rate for Payer: Multiplan Commercial |
$1,817.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,362.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,089.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.97
|
| Rate for Payer: Quartz Commercial |
$1,476.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.82
|
| Rate for Payer: The Alliance Commercial |
$1,135.68
|
| Rate for Payer: WEA Trust Commercial |
$1,249.25
|
| Rate for Payer: WPS Commercial |
$1,682.34
|
|
|
LASER FIBER MOSES 200 AC-10030100
|
Facility
|
OP
|
$4,456.25
|
|
| Hospital Charge Code |
6248126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,297.66 |
| Max. Negotiated Rate |
$4,263.74 |
| Rate for Payer: Aetna Commercial |
$4,171.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,985.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,297.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,012.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,317.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,224.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,456.28
|
| Rate for Payer: Cash Price |
$1,336.88
|
| Rate for Payer: Cigna Commercial |
$4,263.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,593.54
|
| Rate for Payer: Health EOS Commercial |
$4,124.70
|
| Rate for Payer: HFN Commercial |
$4,263.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,475.88
|
| Rate for Payer: Multiplan Commercial |
$3,707.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,780.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,263.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.91
|
| Rate for Payer: Quartz Commercial |
$3,012.43
|
| Rate for Payer: Quartz Medicare Advantage |
$2,780.70
|
| Rate for Payer: The Alliance Commercial |
$2,317.25
|
| Rate for Payer: WEA Trust Commercial |
$2,548.97
|
| Rate for Payer: WPS Commercial |
$3,432.65
|
|
|
LASER FIBER MOSES 200 AC-10030100
|
Facility
|
IP
|
$4,456.25
|
|
| Hospital Charge Code |
6248126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,270.91 |
| Max. Negotiated Rate |
$4,263.74 |
| Rate for Payer: Aetna Commercial |
$4,171.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,985.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,456.28
|
| Rate for Payer: Cash Price |
$1,336.88
|
| Rate for Payer: Cigna Commercial |
$4,263.74
|
| Rate for Payer: Health EOS Commercial |
$4,124.70
|
| Rate for Payer: HFN Commercial |
$4,263.74
|
| Rate for Payer: Multiplan Commercial |
$3,707.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,263.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.91
|
| Rate for Payer: Quartz Commercial |
$2,780.70
|
| Rate for Payer: WEA Trust Commercial |
$2,548.97
|
| Rate for Payer: WPS Commercial |
$3,432.65
|
|
|
LASER FIBER MOSES 365 AC-10030110
|
Facility
|
IP
|
$3,555.99
|
|
| Hospital Charge Code |
6248127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,812.13 |
| Max. Negotiated Rate |
$3,402.37 |
| Rate for Payer: Aetna Commercial |
$3,328.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,180.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,960.06
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$3,402.37
|
| Rate for Payer: Health EOS Commercial |
$3,291.42
|
| Rate for Payer: HFN Commercial |
$3,402.37
|
| Rate for Payer: Multiplan Commercial |
$2,958.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,402.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,812.13
|
| Rate for Payer: Quartz Commercial |
$2,218.94
|
| Rate for Payer: WEA Trust Commercial |
$2,034.03
|
| Rate for Payer: WPS Commercial |
$2,739.18
|
|
|
LASER FIBER MOSES 365 AC-10030110
|
Facility
|
OP
|
$3,555.99
|
|
| Hospital Charge Code |
6248127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,035.50 |
| Max. Negotiated Rate |
$3,402.37 |
| Rate for Payer: Aetna Commercial |
$3,328.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,180.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,035.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,403.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,849.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,775.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,960.06
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$3,402.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,069.59
|
| Rate for Payer: Health EOS Commercial |
$3,291.42
|
| Rate for Payer: HFN Commercial |
$3,402.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,773.67
|
| Rate for Payer: Multiplan Commercial |
$2,958.58
|
| Rate for Payer: NAPHCARE Commercial |
$2,218.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,402.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,812.13
|
| Rate for Payer: Quartz Commercial |
$2,403.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,218.94
|
| Rate for Payer: The Alliance Commercial |
$1,849.11
|
| Rate for Payer: WEA Trust Commercial |
$2,034.03
|
| Rate for Payer: WPS Commercial |
$2,739.18
|
|
|
LASER FIBER MOSES 550 AC-10030120
|
Facility
|
IP
|
$3,612.15
|
|
| Hospital Charge Code |
6248128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,840.75 |
| Max. Negotiated Rate |
$3,456.11 |
| Rate for Payer: Aetna Commercial |
$3,380.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,230.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.02
|
| Rate for Payer: Cash Price |
$1,083.64
|
| Rate for Payer: Cigna Commercial |
$3,456.11
|
| Rate for Payer: Health EOS Commercial |
$3,343.41
|
| Rate for Payer: HFN Commercial |
$3,456.11
|
| Rate for Payer: Multiplan Commercial |
$3,005.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,456.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.75
|
| Rate for Payer: Quartz Commercial |
$2,253.98
|
| Rate for Payer: WEA Trust Commercial |
$2,066.15
|
| Rate for Payer: WPS Commercial |
$2,782.44
|
|
|
LASER FIBER MOSES 550 AC-10030120
|
Facility
|
OP
|
$3,612.15
|
|
| Hospital Charge Code |
6248128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,051.86 |
| Max. Negotiated Rate |
$3,456.11 |
| Rate for Payer: Aetna Commercial |
$3,380.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,230.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,051.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,441.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,878.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.02
|
| Rate for Payer: Cash Price |
$1,083.64
|
| Rate for Payer: Cigna Commercial |
$3,456.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.27
|
| Rate for Payer: Health EOS Commercial |
$3,343.41
|
| Rate for Payer: HFN Commercial |
$3,456.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,817.48
|
| Rate for Payer: Multiplan Commercial |
$3,005.31
|
| Rate for Payer: NAPHCARE Commercial |
$2,253.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,456.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.75
|
| Rate for Payer: Quartz Commercial |
$2,441.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,253.98
|
| Rate for Payer: The Alliance Commercial |
$1,878.32
|
| Rate for Payer: WEA Trust Commercial |
$2,066.15
|
| Rate for Payer: WPS Commercial |
$2,782.44
|
|
|
LASER, LITHOTRIPSY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2950341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
LASER, LITHOTRIPSY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2950341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
