|
2001895- 2 1/4 Wafer- 2 pc app
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
5375219
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
2001899- Adapt convex rings 20mm
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
5375226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
2001899- Adapt convex rings 20mm
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
5375226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
2001900- Adapt convex rings 30mm
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
5375227
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
2001900- Adapt convex rings 30mm
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
5375227
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
2001901- Adapt convex rings 40mm
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
5375228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
2001901- Adapt convex rings 40mm
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
5375228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
2002014- 2 1/4 Pouch- 2 pc app
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS A5063
|
| Hospital Charge Code |
5375217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.06
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
2002014- 2 1/4 Pouch- 2 pc app
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS A5063
|
| Hospital Charge Code |
5375217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
20 - Catheter size
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2999973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
20 - Catheter size
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2999973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
20 G 2*6231""
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040301
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
20 G 2*6231""
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040301
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
2.0MM LC-DCP PLATE 4H/27MM 243.584
|
Facility
|
OP
|
$3,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.97 |
| Max. Negotiated Rate |
$3,384.20 |
| Rate for Payer: Aetna Commercial |
$3,310.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,163.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,029.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,391.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,839.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,765.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,949.59
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cigna Commercial |
$3,384.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,058.53
|
| Rate for Payer: Health EOS Commercial |
$3,273.85
|
| Rate for Payer: HFN Commercial |
$3,384.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,758.86
|
| Rate for Payer: Multiplan Commercial |
$2,942.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,207.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,384.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,802.46
|
| Rate for Payer: Quartz Commercial |
$2,391.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,207.09
|
| Rate for Payer: The Alliance Commercial |
$1,839.24
|
| Rate for Payer: WEA Trust Commercial |
$2,023.16
|
| Rate for Payer: WPS Commercial |
$2,724.55
|
|
|
2.0MM LC-DCP PLATE 4H/27MM 243.584
|
Facility
|
IP
|
$3,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,802.46 |
| Max. Negotiated Rate |
$3,384.20 |
| Rate for Payer: Aetna Commercial |
$3,310.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,163.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,949.59
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cigna Commercial |
$3,384.20
|
| Rate for Payer: Health EOS Commercial |
$3,273.85
|
| Rate for Payer: HFN Commercial |
$3,384.20
|
| Rate for Payer: Multiplan Commercial |
$2,942.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,384.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,802.46
|
| Rate for Payer: Quartz Commercial |
$2,207.09
|
| Rate for Payer: WEA Trust Commercial |
$2,023.16
|
| Rate for Payer: WPS Commercial |
$2,724.55
|
|
|
2.0MM LC-DCP PLATE 8H/51MM 243.588
|
Facility
|
OP
|
$4,757.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.24 |
| Max. Negotiated Rate |
$4,551.50 |
| Rate for Payer: Aetna Commercial |
$4,452.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,254.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,385.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,215.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,473.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,374.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,622.06
|
| Rate for Payer: Cash Price |
$1,427.10
|
| Rate for Payer: Cigna Commercial |
$4,551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,768.57
|
| Rate for Payer: Health EOS Commercial |
$4,403.08
|
| Rate for Payer: HFN Commercial |
$4,551.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,710.46
|
| Rate for Payer: Multiplan Commercial |
$3,957.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,968.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,551.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,424.17
|
| Rate for Payer: Quartz Commercial |
$3,215.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,968.37
|
| Rate for Payer: The Alliance Commercial |
$2,473.64
|
| Rate for Payer: WEA Trust Commercial |
$2,721.00
|
| Rate for Payer: WPS Commercial |
$3,664.32
|
|
|
2.0MM LC-DCP PLATE 8H/51MM 243.588
|
Facility
|
IP
|
$4,757.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,424.17 |
| Max. Negotiated Rate |
$4,551.50 |
| Rate for Payer: Aetna Commercial |
$4,452.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,254.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,622.06
|
| Rate for Payer: Cash Price |
$1,427.10
|
| Rate for Payer: Cigna Commercial |
$4,551.50
|
| Rate for Payer: Health EOS Commercial |
$4,403.08
|
| Rate for Payer: HFN Commercial |
$4,551.50
|
| Rate for Payer: Multiplan Commercial |
$3,957.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,551.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,424.17
|
| Rate for Payer: Quartz Commercial |
$2,968.37
|
| Rate for Payer: WEA Trust Commercial |
$2,721.00
|
| Rate for Payer: WPS Commercial |
$3,664.32
|
|
|
2.0MM STR PLATE 6H 247.031
|
Facility
|
IP
|
$3,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$3,465.53 |
| Rate for Payer: Aetna Commercial |
$3,390.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,996.45
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Cigna Commercial |
$3,465.53
|
| Rate for Payer: Health EOS Commercial |
$3,352.52
|
| Rate for Payer: HFN Commercial |
$3,465.53
|
| Rate for Payer: Multiplan Commercial |
$3,013.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,465.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,845.77
|
| Rate for Payer: Quartz Commercial |
$2,260.13
|
| Rate for Payer: WEA Trust Commercial |
$2,071.78
|
| Rate for Payer: WPS Commercial |
$2,790.03
|
|
|
2.0MM STR PLATE 6H 247.031
|
Facility
|
OP
|
$3,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,054.73 |
| Max. Negotiated Rate |
$3,465.53 |
| Rate for Payer: Aetna Commercial |
$3,390.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,239.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,054.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,448.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,883.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,808.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,996.45
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Cigna Commercial |
$3,465.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,108.00
|
| Rate for Payer: Health EOS Commercial |
$3,352.52
|
| Rate for Payer: HFN Commercial |
$3,465.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,825.16
|
| Rate for Payer: Multiplan Commercial |
$3,013.50
|
| Rate for Payer: NAPHCARE Commercial |
$2,260.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,465.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,845.77
|
| Rate for Payer: Quartz Commercial |
$2,448.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,260.13
|
| Rate for Payer: The Alliance Commercial |
$1,883.44
|
| Rate for Payer: WEA Trust Commercial |
$2,071.78
|
| Rate for Payer: WPS Commercial |
$2,790.03
|
|
|
2.0MM T-PLATE 2H HEAD/ 8H SHAFT 247.232
|
Facility
|
IP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,026.17 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,481.02
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
2.0MM T-PLATE 2H HEAD/ 8H SHAFT 247.232
|
Facility
|
OP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.81 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,157.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,687.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,067.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,984.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,314.03
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,101.28
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: NAPHCARE Commercial |
$2,481.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,687.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,481.02
|
| Rate for Payer: The Alliance Commercial |
$2,067.52
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
2.0MM T-PLATE 3H HEAD/ 8H SHAFT 247.233
|
Facility
|
OP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.90 |
| Max. Negotiated Rate |
$4,142.94 |
| Rate for Payer: Aetna Commercial |
$4,052.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,872.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,260.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,927.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,251.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,161.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,386.70
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$4,142.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,520.06
|
| Rate for Payer: Health EOS Commercial |
$4,007.85
|
| Rate for Payer: HFN Commercial |
$4,142.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,377.40
|
| Rate for Payer: Multiplan Commercial |
$3,602.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,701.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,142.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,206.57
|
| Rate for Payer: Quartz Commercial |
$2,927.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,701.92
|
| Rate for Payer: The Alliance Commercial |
$2,251.60
|
| Rate for Payer: WEA Trust Commercial |
$2,476.76
|
| Rate for Payer: WPS Commercial |
$3,335.40
|
|
|
2.0MM T-PLATE 3H HEAD/ 8H SHAFT 247.233
|
Facility
|
IP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.57 |
| Max. Negotiated Rate |
$4,142.94 |
| Rate for Payer: Aetna Commercial |
$4,052.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,872.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,386.70
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$4,142.94
|
| Rate for Payer: Health EOS Commercial |
$4,007.85
|
| Rate for Payer: HFN Commercial |
$4,142.94
|
| Rate for Payer: Multiplan Commercial |
$3,602.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,142.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,206.57
|
| Rate for Payer: Quartz Commercial |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$2,476.76
|
| Rate for Payer: WPS Commercial |
$3,335.40
|
|
|
21Ga 3/4 Butterfly
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
21Ga 3/4 Butterfly
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3040363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
