|
2001895- 2 1/4 Wafer- 2 pc app
|
Facility
OP
|
$56.00
|
|
| Hospital Charge Code |
5375219
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$33.60
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
2001899- Adapt convex rings 20mm
|
Facility
OP
|
$94.00
|
|
| Hospital Charge Code |
5375226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
2001899- Adapt convex rings 20mm
|
Facility
IP
|
$94.00
|
|
| Hospital Charge Code |
5375226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
2001900- Adapt convex rings 30mm
|
Facility
IP
|
$94.00
|
|
| Hospital Charge Code |
5375227
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
2001900- Adapt convex rings 30mm
|
Facility
OP
|
$94.00
|
|
| Hospital Charge Code |
5375227
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
2001901- Adapt convex rings 40mm
|
Facility
OP
|
$89.00
|
|
| Hospital Charge Code |
5375228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
2001901- Adapt convex rings 40mm
|
Facility
IP
|
$89.00
|
|
| Hospital Charge Code |
5375228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
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 |
$8.96 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.91
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
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 |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
20 - Catheter size
|
Facility
IP
|
$93.00
|
|
| Hospital Charge Code |
2999973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
20 - Catheter size
|
Facility
OP
|
$93.00
|
|
| Hospital Charge Code |
2999973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
20 G 2*6231""
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
3040301
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
20 G 2*6231""
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
3040301
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
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 |
$1,733.13 |
| Max. Negotiated Rate |
$3,254.04 |
| Rate for Payer: Aetna Commercial |
$3,183.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,874.61
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cigna Commercial |
$3,254.04
|
| Rate for Payer: Health EOS Commercial |
$3,147.93
|
| Rate for Payer: HFN Commercial |
$3,254.04
|
| Rate for Payer: Multiplan Commercial |
$2,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,122.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,254.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.13
|
| Rate for Payer: Quartz Commercial |
$2,122.20
|
| Rate for Payer: WEA Trust Commercial |
$1,945.35
|
| Rate for Payer: WPS Commercial |
$2,619.86
|
|
|
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 |
$990.36 |
| Max. Negotiated Rate |
$3,254.04 |
| Rate for Payer: Aetna Commercial |
$3,183.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,041.82
|
| Rate for Payer: Aetna Managed Medicare |
$990.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,299.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,697.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,874.61
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cigna Commercial |
$3,254.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,979.31
|
| Rate for Payer: Health EOS Commercial |
$3,147.93
|
| Rate for Payer: HFN Commercial |
$3,254.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,652.75
|
| Rate for Payer: Multiplan Commercial |
$2,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,122.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,254.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.13
|
| Rate for Payer: Quartz Commercial |
$2,299.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,122.20
|
| Rate for Payer: WEA Trust Commercial |
$1,945.35
|
| Rate for Payer: WPS Commercial |
$2,619.86
|
|
|
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 |
$1,331.96 |
| Max. Negotiated Rate |
$4,376.44 |
| Rate for Payer: Aetna Commercial |
$4,281.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,331.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,092.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,378.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,283.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.21
|
| Rate for Payer: Cash Price |
$1,427.10
|
| Rate for Payer: Cigna Commercial |
$4,376.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,662.02
|
| Rate for Payer: Health EOS Commercial |
$4,233.73
|
| Rate for Payer: HFN Commercial |
$4,376.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,567.75
|
| Rate for Payer: Multiplan Commercial |
$3,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,376.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,330.93
|
| Rate for Payer: Quartz Commercial |
$3,092.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,854.20
|
| Rate for Payer: WEA Trust Commercial |
$2,616.35
|
| Rate for Payer: WPS Commercial |
$3,523.51
|
|
|
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 |
$2,330.93 |
| Max. Negotiated Rate |
$4,376.44 |
| Rate for Payer: Aetna Commercial |
$4,281.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.21
|
| Rate for Payer: Cash Price |
$1,427.10
|
| Rate for Payer: Cigna Commercial |
$4,376.44
|
| Rate for Payer: Health EOS Commercial |
$4,233.73
|
| Rate for Payer: HFN Commercial |
$4,376.44
|
| Rate for Payer: Multiplan Commercial |
$3,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,376.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,330.93
|
| Rate for Payer: Quartz Commercial |
$2,854.20
|
| Rate for Payer: WEA Trust Commercial |
$2,616.35
|
| Rate for Payer: WPS Commercial |
$3,523.51
|
|
|
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 |
$1,014.16 |
| Max. Negotiated Rate |
$3,332.24 |
| Rate for Payer: Aetna Commercial |
$3,259.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,114.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,014.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,354.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,811.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,738.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,919.66
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Cigna Commercial |
$3,332.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,026.87
|
| Rate for Payer: Health EOS Commercial |
$3,223.58
|
| Rate for Payer: HFN Commercial |
$3,332.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,716.50
|
| Rate for Payer: Multiplan Commercial |
$2,897.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,173.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,332.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,774.78
|
| Rate for Payer: Quartz Commercial |
$2,354.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,173.20
|
| Rate for Payer: WEA Trust Commercial |
$1,992.10
|
| Rate for Payer: WPS Commercial |
$2,682.82
|
|
|
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 |
$1,774.78 |
| Max. Negotiated Rate |
$3,332.24 |
| Rate for Payer: Aetna Commercial |
$3,259.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,919.66
|
| Rate for Payer: Cash Price |
$1,086.60
|
| Rate for Payer: Cigna Commercial |
$3,332.24
|
| Rate for Payer: Health EOS Commercial |
$3,223.58
|
| Rate for Payer: HFN Commercial |
$3,332.24
|
| Rate for Payer: Multiplan Commercial |
$2,897.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,173.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,332.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,774.78
|
| Rate for Payer: Quartz Commercial |
$2,173.20
|
| Rate for Payer: WEA Trust Commercial |
$1,992.10
|
| Rate for Payer: WPS Commercial |
$2,682.82
|
|
|
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 |
$1,113.28 |
| Max. Negotiated Rate |
$3,657.92 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,113.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,584.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,988.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,908.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,224.97
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,982.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,584.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,385.60
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
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 |
$1,948.24 |
| Max. Negotiated Rate |
$3,657.92 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,385.60
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
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 |
$1,212.40 |
| Max. Negotiated Rate |
$3,983.60 |
| Rate for Payer: Aetna Commercial |
$3,897.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,723.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,212.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,814.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,078.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,294.90
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$3,983.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,423.07
|
| Rate for Payer: Health EOS Commercial |
$3,853.70
|
| Rate for Payer: HFN Commercial |
$3,983.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,247.50
|
| Rate for Payer: Multiplan Commercial |
$3,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,983.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,121.70
|
| Rate for Payer: Quartz Commercial |
$2,814.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$2,381.50
|
| Rate for Payer: WPS Commercial |
$3,207.23
|
|
|
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 |
$2,121.70 |
| Max. Negotiated Rate |
$3,983.60 |
| Rate for Payer: Aetna Commercial |
$3,897.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,294.90
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$3,983.60
|
| Rate for Payer: Health EOS Commercial |
$3,853.70
|
| Rate for Payer: HFN Commercial |
$3,983.60
|
| Rate for Payer: Multiplan Commercial |
$3,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,983.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,121.70
|
| Rate for Payer: Quartz Commercial |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$2,381.50
|
| Rate for Payer: WPS Commercial |
$3,207.23
|
|
|
21Ga 3/4 Butterfly
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
3040363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
21Ga 3/4 Butterfly
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
3040363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
