|
MYOtherm XP 4;1 Bridge Coated
|
Facility
|
OP
|
$1,983.00
|
|
| Hospital Charge Code |
2975047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.45 |
| Max. Negotiated Rate |
$1,897.33 |
| Rate for Payer: Aetna Commercial |
$1,856.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.60
|
| Rate for Payer: Aetna Managed Medicare |
$577.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,340.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,031.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$989.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.03
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,897.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,154.11
|
| Rate for Payer: Health EOS Commercial |
$1,835.46
|
| Rate for Payer: HFN Commercial |
$1,897.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,546.74
|
| Rate for Payer: Multiplan Commercial |
$1,649.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.54
|
| Rate for Payer: Quartz Commercial |
$1,340.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,237.39
|
| Rate for Payer: The Alliance Commercial |
$1,031.16
|
| Rate for Payer: WEA Trust Commercial |
$1,134.28
|
| Rate for Payer: WPS Commercial |
$1,527.50
|
|
|
MYOtherm XP 4;1 Bridge Coated
|
Facility
|
IP
|
$1,983.00
|
|
| Hospital Charge Code |
2975047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.54 |
| Max. Negotiated Rate |
$1,897.33 |
| Rate for Payer: Aetna Commercial |
$1,856.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.03
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,897.33
|
| Rate for Payer: Health EOS Commercial |
$1,835.46
|
| Rate for Payer: HFN Commercial |
$1,897.33
|
| Rate for Payer: Multiplan Commercial |
$1,649.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.54
|
| Rate for Payer: Quartz Commercial |
$1,237.39
|
| Rate for Payer: WEA Trust Commercial |
$1,134.28
|
| Rate for Payer: WPS Commercial |
$1,527.50
|
|
|
MYOtherm XP 4:1 Coated
|
Facility
|
OP
|
$1,907.00
|
|
| Hospital Charge Code |
2975046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.32 |
| Max. Negotiated Rate |
$1,824.62 |
| Rate for Payer: Aetna Commercial |
$1,784.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.62
|
| Rate for Payer: Aetna Managed Medicare |
$555.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,289.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.14
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,824.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.87
|
| Rate for Payer: Health EOS Commercial |
$1,765.12
|
| Rate for Payer: HFN Commercial |
$1,824.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.46
|
| Rate for Payer: Multiplan Commercial |
$1,586.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.62
|
| Rate for Payer: Quartz Beloit One Network |
$971.81
|
| Rate for Payer: Quartz Commercial |
$1,289.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.97
|
| Rate for Payer: The Alliance Commercial |
$991.64
|
| Rate for Payer: WEA Trust Commercial |
$1,090.80
|
| Rate for Payer: WPS Commercial |
$1,468.96
|
|
|
MYOtherm XP 4:1 Coated
|
Facility
|
IP
|
$1,907.00
|
|
| Hospital Charge Code |
2975046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.81 |
| Max. Negotiated Rate |
$1,824.62 |
| Rate for Payer: Aetna Commercial |
$1,784.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.14
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,824.62
|
| Rate for Payer: Health EOS Commercial |
$1,765.12
|
| Rate for Payer: HFN Commercial |
$1,824.62
|
| Rate for Payer: Multiplan Commercial |
$1,586.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.62
|
| Rate for Payer: Quartz Beloit One Network |
$971.81
|
| Rate for Payer: Quartz Commercial |
$1,189.97
|
| Rate for Payer: WEA Trust Commercial |
$1,090.80
|
| Rate for Payer: WPS Commercial |
$1,468.96
|
|
|
MYOTHERM XP DELIVERY LINE
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2975048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$197.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$182.21
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
MYOTHERM XP DELIVERY LINE
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2975048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
Myotonic Dystrophy DNA Test
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
983340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$626.91 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$562.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$626.91
|
|
|
Myotonic Dystrophy DNA Test
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
983340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
Myotonic Dystrophy DNA Test
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
983340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$569.92 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$433.68
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
Myringotomy Incision With Aspiration Or Inflation
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
1152800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.61 |
| Max. Negotiated Rate |
$484.24 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$107.61
|
| Rate for Payer: Anthem Medicare Advantage |
$107.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.61
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$380.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.61
|
| Rate for Payer: Health EOS Commercial |
$364.36
|
| Rate for Payer: HFN Commercial |
$380.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$414.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.61
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$380.38
|
| Rate for Payer: Quartz Beloit One Network |
$176.18
|
| Rate for Payer: Quartz Commercial |
$228.23
|
| Rate for Payer: Quartz Medicare Advantage |
$107.61
|
| Rate for Payer: The Alliance Commercial |
$457.34
|
| Rate for Payer: United Healthcare Medicaid |
$168.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.61
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$484.24
|
|
|
Myringotomy Incision with Aspiration or Inflation 6979969420
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 69799
|
| Hospital Charge Code |
5322652
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.67 |
| Max. Negotiated Rate |
$392.24 |
| Rate for Payer: Aetna Commercial |
$392.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$392.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.73
|
| Rate for Payer: Health EOS Commercial |
$375.72
|
| Rate for Payer: HFN Commercial |
$392.24
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$392.24
|
| Rate for Payer: Quartz Beloit One Network |
$181.67
|
| Rate for Payer: Quartz Commercial |
$235.34
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
MYRINGOTOMY WITHOUT BUTTONS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
MYRINGOTOMY WITHOUT BUTTONS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
NAIL 11MM TITANIUM TIBIAL
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
NAIL 11MM TITANIUM TIBIAL
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,939.04 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,047.81
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
NAIL 12MM/125D TI TROCHANTERIC
|
Facility
|
OP
|
$11,403.00
|
|
| Hospital Charge Code |
2966284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,320.55 |
| Max. Negotiated Rate |
$10,910.39 |
| Rate for Payer: Aetna Commercial |
$10,673.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,198.84
|
| Rate for Payer: Aetna Managed Medicare |
$3,320.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,708.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,929.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,692.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,285.33
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cigna Commercial |
$10,910.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,636.55
|
| Rate for Payer: Health EOS Commercial |
$10,554.62
|
| Rate for Payer: HFN Commercial |
$10,910.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,894.34
|
| Rate for Payer: Multiplan Commercial |
$9,487.30
|
| Rate for Payer: NAPHCARE Commercial |
$7,115.47
|
| Rate for Payer: Preferred Network Access Commercial |
$10,910.39
|
| Rate for Payer: Quartz Beloit One Network |
$5,810.97
|
| Rate for Payer: Quartz Commercial |
$7,708.43
|
| Rate for Payer: Quartz Medicare Advantage |
$7,115.47
|
| Rate for Payer: The Alliance Commercial |
$5,929.56
|
| Rate for Payer: WEA Trust Commercial |
$6,522.52
|
| Rate for Payer: WPS Commercial |
$8,783.73
|
|
|
NAIL 12MM/125D TI TROCHANTERIC
|
Facility
|
IP
|
$11,403.00
|
|
| Hospital Charge Code |
2966284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,810.97 |
| Max. Negotiated Rate |
$10,910.39 |
| Rate for Payer: Aetna Commercial |
$10,673.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,198.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,285.33
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cigna Commercial |
$10,910.39
|
| Rate for Payer: Health EOS Commercial |
$10,554.62
|
| Rate for Payer: HFN Commercial |
$10,910.39
|
| Rate for Payer: Multiplan Commercial |
$9,487.30
|
| Rate for Payer: Preferred Network Access Commercial |
$10,910.39
|
| Rate for Payer: Quartz Beloit One Network |
$5,810.97
|
| Rate for Payer: Quartz Commercial |
$7,115.47
|
| Rate for Payer: WEA Trust Commercial |
$6,522.52
|
| Rate for Payer: WPS Commercial |
$8,783.73
|
|
|
NAIL 12x330 CANN TIBIAL
|
Facility
|
IP
|
$8,977.00
|
|
| Hospital Charge Code |
2966285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,574.68 |
| Max. Negotiated Rate |
$8,589.19 |
| Rate for Payer: Aetna Commercial |
$8,402.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,029.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,948.12
|
| Rate for Payer: Cash Price |
$2,693.10
|
| Rate for Payer: Cigna Commercial |
$8,589.19
|
| Rate for Payer: Health EOS Commercial |
$8,309.11
|
| Rate for Payer: HFN Commercial |
$8,589.19
|
| Rate for Payer: Multiplan Commercial |
$7,468.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,589.19
|
| Rate for Payer: Quartz Beloit One Network |
$4,574.68
|
| Rate for Payer: Quartz Commercial |
$5,601.65
|
| Rate for Payer: WEA Trust Commercial |
$5,134.84
|
| Rate for Payer: WPS Commercial |
$6,914.98
|
|
|
NAIL 12x330 CANN TIBIAL
|
Facility
|
OP
|
$8,977.00
|
|
| Hospital Charge Code |
2966285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.10 |
| Max. Negotiated Rate |
$8,589.19 |
| Rate for Payer: Aetna Commercial |
$8,402.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,029.03
|
| Rate for Payer: Aetna Managed Medicare |
$2,614.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,068.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,668.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,481.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,948.12
|
| Rate for Payer: Cash Price |
$2,693.10
|
| Rate for Payer: Cigna Commercial |
$8,589.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,224.61
|
| Rate for Payer: Health EOS Commercial |
$8,309.11
|
| Rate for Payer: HFN Commercial |
$8,589.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,002.06
|
| Rate for Payer: Multiplan Commercial |
$7,468.86
|
| Rate for Payer: NAPHCARE Commercial |
$5,601.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,589.19
|
| Rate for Payer: Quartz Beloit One Network |
$4,574.68
|
| Rate for Payer: Quartz Commercial |
$6,068.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,601.65
|
| Rate for Payer: The Alliance Commercial |
$4,668.04
|
| Rate for Payer: WEA Trust Commercial |
$5,134.84
|
| Rate for Payer: WPS Commercial |
$6,914.98
|
|
|
NAIL 20MM BIOTRAK HELICAL
|
Facility
|
OP
|
$6,589.00
|
|
| Hospital Charge Code |
3072631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,918.72 |
| Max. Negotiated Rate |
$6,304.36 |
| Rate for Payer: Aetna Commercial |
$6,167.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,893.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,918.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,454.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,426.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,289.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,631.86
|
| Rate for Payer: Cash Price |
$1,976.70
|
| Rate for Payer: Cigna Commercial |
$6,304.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,834.80
|
| Rate for Payer: Health EOS Commercial |
$6,098.78
|
| Rate for Payer: HFN Commercial |
$6,304.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,139.42
|
| Rate for Payer: Multiplan Commercial |
$5,482.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,111.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,357.75
|
| Rate for Payer: Quartz Commercial |
$4,454.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,111.54
|
| Rate for Payer: The Alliance Commercial |
$3,426.28
|
| Rate for Payer: WEA Trust Commercial |
$3,768.91
|
| Rate for Payer: WPS Commercial |
$5,075.51
|
|
|
NAIL 20MM BIOTRAK HELICAL
|
Facility
|
IP
|
$6,589.00
|
|
| Hospital Charge Code |
3072631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.75 |
| Max. Negotiated Rate |
$6,304.36 |
| Rate for Payer: Aetna Commercial |
$6,167.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,893.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,631.86
|
| Rate for Payer: Cash Price |
$1,976.70
|
| Rate for Payer: Cigna Commercial |
$6,304.36
|
| Rate for Payer: Health EOS Commercial |
$6,098.78
|
| Rate for Payer: HFN Commercial |
$6,304.36
|
| Rate for Payer: Multiplan Commercial |
$5,482.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,357.75
|
| Rate for Payer: Quartz Commercial |
$4,111.54
|
| Rate for Payer: WEA Trust Commercial |
$3,768.91
|
| Rate for Payer: WPS Commercial |
$5,075.51
|
|
|
NAIL 408.890
|
Facility
|
IP
|
$6,527.00
|
|
| Hospital Charge Code |
2966288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.16 |
| Max. Negotiated Rate |
$6,245.03 |
| Rate for Payer: Aetna Commercial |
$6,109.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,837.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,597.68
|
| Rate for Payer: Cash Price |
$1,958.10
|
| Rate for Payer: Cigna Commercial |
$6,245.03
|
| Rate for Payer: Health EOS Commercial |
$6,041.39
|
| Rate for Payer: HFN Commercial |
$6,245.03
|
| Rate for Payer: Multiplan Commercial |
$5,430.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,245.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,326.16
|
| Rate for Payer: Quartz Commercial |
$4,072.85
|
| Rate for Payer: WEA Trust Commercial |
$3,733.44
|
| Rate for Payer: WPS Commercial |
$5,027.75
|
|
|
NAIL 408.890
|
Facility
|
OP
|
$6,527.00
|
|
| Hospital Charge Code |
2966288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.66 |
| Max. Negotiated Rate |
$6,245.03 |
| Rate for Payer: Aetna Commercial |
$6,109.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,837.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,900.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,412.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,394.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,258.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,597.68
|
| Rate for Payer: Cash Price |
$1,958.10
|
| Rate for Payer: Cigna Commercial |
$6,245.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,798.71
|
| Rate for Payer: Health EOS Commercial |
$6,041.39
|
| Rate for Payer: HFN Commercial |
$6,245.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,091.06
|
| Rate for Payer: Multiplan Commercial |
$5,430.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,072.85
|
| Rate for Payer: Preferred Network Access Commercial |
$6,245.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,326.16
|
| Rate for Payer: Quartz Commercial |
$4,412.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,072.85
|
| Rate for Payer: The Alliance Commercial |
$3,394.04
|
| Rate for Payer: WEA Trust Commercial |
$3,733.44
|
| Rate for Payer: WPS Commercial |
$5,027.75
|
|
|
NAIL AND END CAP OLECRANON
|
Facility
|
IP
|
$6,269.00
|
|
| Hospital Charge Code |
2966291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,194.68 |
| Max. Negotiated Rate |
$5,998.18 |
| Rate for Payer: Aetna Commercial |
$5,867.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,606.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,455.47
|
| Rate for Payer: Cash Price |
$1,880.70
|
| Rate for Payer: Cigna Commercial |
$5,998.18
|
| Rate for Payer: Health EOS Commercial |
$5,802.59
|
| Rate for Payer: HFN Commercial |
$5,998.18
|
| Rate for Payer: Multiplan Commercial |
$5,215.81
|
| Rate for Payer: Preferred Network Access Commercial |
$5,998.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,194.68
|
| Rate for Payer: Quartz Commercial |
$3,911.86
|
| Rate for Payer: WEA Trust Commercial |
$3,585.87
|
| Rate for Payer: WPS Commercial |
$4,829.01
|
|
