|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9207S
|
Facility
|
IP
|
$2,926.00
|
|
| Hospital Charge Code |
4628647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.09 |
| Max. Negotiated Rate |
$2,799.60 |
| Rate for Payer: Aetna Commercial |
$2,738.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,612.81
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,799.60
|
| Rate for Payer: Health EOS Commercial |
$2,708.31
|
| Rate for Payer: HFN Commercial |
$2,799.60
|
| Rate for Payer: Multiplan Commercial |
$2,434.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.09
|
| Rate for Payer: Quartz Commercial |
$1,825.82
|
| Rate for Payer: WEA Trust Commercial |
$1,673.67
|
| Rate for Payer: WPS Commercial |
$2,253.90
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9207S
|
Facility
|
OP
|
$2,926.00
|
|
| Hospital Charge Code |
4628647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.05 |
| Max. Negotiated Rate |
$2,799.60 |
| Rate for Payer: Aetna Commercial |
$2,738.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.01
|
| Rate for Payer: Aetna Managed Medicare |
$852.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,977.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,521.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,460.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,612.81
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,799.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,702.93
|
| Rate for Payer: Health EOS Commercial |
$2,708.31
|
| Rate for Payer: HFN Commercial |
$2,799.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,282.28
|
| Rate for Payer: Multiplan Commercial |
$2,434.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,825.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.09
|
| Rate for Payer: Quartz Commercial |
$1,977.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,825.82
|
| Rate for Payer: The Alliance Commercial |
$1,521.52
|
| Rate for Payer: WEA Trust Commercial |
$1,673.67
|
| Rate for Payer: WPS Commercial |
$2,253.90
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9507S
|
Facility
|
IP
|
$4,255.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4595597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.35 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,655.12
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9507S
|
Facility
|
OP
|
$4,255.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4595597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.06 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,212.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.41
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,318.90
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,876.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.12
|
| Rate for Payer: The Alliance Commercial |
$2,212.60
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SET UNIVERS REVERS MODULAR AR-9607S
|
Facility
|
OP
|
$4,255.00
|
|
| Hospital Charge Code |
5496852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,239.06 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,212.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.41
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,318.90
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,876.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.12
|
| Rate for Payer: The Alliance Commercial |
$2,212.60
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SET UNIVERS REVERS MODULAR AR-9607S
|
Facility
|
IP
|
$4,255.00
|
|
| Hospital Charge Code |
5496852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,168.35 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,655.12
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SNAP-OFF 1.9MM X 10MM FULL THREAD AR-9919-10
|
Facility
|
OP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Aetna Managed Medicare |
$973.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,259.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,737.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,668.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,944.95
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,606.64
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,085.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,259.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,085.31
|
| Rate for Payer: The Alliance Commercial |
$1,737.76
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN SNAP-OFF 1.9MM X 10MM FULL THREAD AR-9919-10
|
Facility
|
IP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,085.31
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN SNAP-OFF 1.9MM X 12MM FULL THREAD AR-9919-12
|
Facility
|
OP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Aetna Managed Medicare |
$973.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,259.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,737.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,668.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,944.95
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,606.64
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,085.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,259.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,085.31
|
| Rate for Payer: The Alliance Commercial |
$1,737.76
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN SNAP-OFF 1.9MM X 12MM FULL THREAD AR-9919-12
|
Facility
|
IP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,085.31
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN STEINMAN TRACTION 4.0 X 200 CENTRAL THREAD 293.72
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$760.66 |
| Rate for Payer: Aetna Commercial |
$744.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.20
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$760.66
|
| Rate for Payer: Health EOS Commercial |
$735.85
|
| Rate for Payer: HFN Commercial |
$760.66
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: Preferred Network Access Commercial |
$760.66
|
| Rate for Payer: Quartz Beloit One Network |
$405.13
|
| Rate for Payer: Quartz Commercial |
$496.08
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$612.39
|
|
|
PIN STEINMAN TRACTION 4.0 X 200 CENTRAL THREAD 293.72
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$760.66 |
| Rate for Payer: Aetna Commercial |
$744.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Aetna Managed Medicare |
$231.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$537.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.20
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$760.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.69
|
| Rate for Payer: Health EOS Commercial |
$735.85
|
| Rate for Payer: HFN Commercial |
$760.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.10
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: NAPHCARE Commercial |
$496.08
|
| Rate for Payer: Preferred Network Access Commercial |
$760.66
|
| Rate for Payer: Quartz Beloit One Network |
$405.13
|
| Rate for Payer: Quartz Commercial |
$537.42
|
| Rate for Payer: Quartz Medicare Advantage |
$496.08
|
| Rate for Payer: The Alliance Commercial |
$413.40
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$612.39
|
|
|
PIN TEMP FIX 2.0MM THREADED ORTHOLOC 59250050
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
6201066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.23 |
| Max. Negotiated Rate |
$1,236.19 |
| Rate for Payer: Aetna Commercial |
$1,209.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.56
|
| Rate for Payer: Aetna Managed Medicare |
$376.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$873.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.15
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cigna Commercial |
$1,236.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.94
|
| Rate for Payer: Health EOS Commercial |
$1,195.88
|
| Rate for Payer: HFN Commercial |
$1,236.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,007.76
|
| Rate for Payer: Multiplan Commercial |
$1,074.94
|
| Rate for Payer: NAPHCARE Commercial |
$806.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.19
|
| Rate for Payer: Quartz Beloit One Network |
$658.40
|
| Rate for Payer: Quartz Commercial |
$873.39
|
| Rate for Payer: Quartz Medicare Advantage |
$806.21
|
| Rate for Payer: The Alliance Commercial |
$671.84
|
| Rate for Payer: WEA Trust Commercial |
$739.02
|
| Rate for Payer: WPS Commercial |
$995.23
|
|
|
PIN TEMP FIX 2.0MM THREADED ORTHOLOC 59250050
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
6201066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$1,236.19 |
| Rate for Payer: Aetna Commercial |
$1,209.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.15
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cigna Commercial |
$1,236.19
|
| Rate for Payer: Health EOS Commercial |
$1,195.88
|
| Rate for Payer: HFN Commercial |
$1,236.19
|
| Rate for Payer: Multiplan Commercial |
$1,074.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.19
|
| Rate for Payer: Quartz Beloit One Network |
$658.40
|
| Rate for Payer: Quartz Commercial |
$806.21
|
| Rate for Payer: WEA Trust Commercial |
$739.02
|
| Rate for Payer: WPS Commercial |
$995.23
|
|
|
PIN TEMP FIXATION1.1MM DC4212
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5957651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.00 |
| Max. Negotiated Rate |
$1,271.59 |
| Rate for Payer: Aetna Commercial |
$1,243.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.66
|
| Rate for Payer: Aetna Managed Medicare |
$387.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.54
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,271.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.48
|
| Rate for Payer: Health EOS Commercial |
$1,230.12
|
| Rate for Payer: HFN Commercial |
$1,271.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,036.62
|
| Rate for Payer: Multiplan Commercial |
$1,105.73
|
| Rate for Payer: NAPHCARE Commercial |
$829.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.59
|
| Rate for Payer: Quartz Beloit One Network |
$677.26
|
| Rate for Payer: Quartz Commercial |
$898.40
|
| Rate for Payer: Quartz Medicare Advantage |
$829.30
|
| Rate for Payer: The Alliance Commercial |
$691.08
|
| Rate for Payer: WEA Trust Commercial |
$760.19
|
| Rate for Payer: WPS Commercial |
$1,023.73
|
|
|
PIN TEMP FIXATION1.1MM DC4212
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5957651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.26 |
| Max. Negotiated Rate |
$1,271.59 |
| Rate for Payer: Aetna Commercial |
$1,243.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.54
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,271.59
|
| Rate for Payer: Health EOS Commercial |
$1,230.12
|
| Rate for Payer: HFN Commercial |
$1,271.59
|
| Rate for Payer: Multiplan Commercial |
$1,105.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.59
|
| Rate for Payer: Quartz Beloit One Network |
$677.26
|
| Rate for Payer: Quartz Commercial |
$829.30
|
| Rate for Payer: WEA Trust Commercial |
$760.19
|
| Rate for Payer: WPS Commercial |
$1,023.73
|
|
|
PIN TRANSFIX 6.0 X 225 294.950
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,561.92 |
| Max. Negotiated Rate |
$2,932.59 |
| Rate for Payer: Aetna Commercial |
$2,868.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,741.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,689.43
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,932.59
|
| Rate for Payer: Health EOS Commercial |
$2,836.96
|
| Rate for Payer: HFN Commercial |
$2,932.59
|
| Rate for Payer: Multiplan Commercial |
$2,550.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,932.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.92
|
| Rate for Payer: Quartz Commercial |
$1,912.56
|
| Rate for Payer: WEA Trust Commercial |
$1,753.18
|
| Rate for Payer: WPS Commercial |
$2,360.97
|
|
|
PIN TRANSFIX 6.0 X 225 294.950
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.53 |
| Max. Negotiated Rate |
$2,932.59 |
| Rate for Payer: Aetna Commercial |
$2,868.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,741.34
|
| Rate for Payer: Aetna Managed Medicare |
$892.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,071.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,593.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,530.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,689.43
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,932.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,783.83
|
| Rate for Payer: Health EOS Commercial |
$2,836.96
|
| Rate for Payer: HFN Commercial |
$2,932.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,390.70
|
| Rate for Payer: Multiplan Commercial |
$2,550.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,912.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,932.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.92
|
| Rate for Payer: Quartz Commercial |
$2,071.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,912.56
|
| Rate for Payer: The Alliance Commercial |
$1,593.80
|
| Rate for Payer: WEA Trust Commercial |
$1,753.18
|
| Rate for Payer: WPS Commercial |
$2,360.97
|
|
|
PIN TRANSFIXING 4mmx200mm 50mm
|
Facility
|
OP
|
$2,025.00
|
|
| Hospital Charge Code |
2966087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Aetna Managed Medicare |
$589.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.55
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.50
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,368.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.60
|
| Rate for Payer: The Alliance Commercial |
$1,053.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.86
|
|
|
PIN TRANSFIXING 4mmx200mm 50mm
|
Facility
|
IP
|
$2,025.00
|
|
| Hospital Charge Code |
2966087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.86
|
|
|
Pinworm Prep
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Pinworm Prep
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
Pinworm Prep
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Pioneer Catheter
|
Facility
|
IP
|
$19,209.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139311
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,788.91 |
| Max. Negotiated Rate |
$18,379.17 |
| Rate for Payer: Aetna Commercial |
$17,979.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,180.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,588.00
|
| Rate for Payer: Cash Price |
$5,762.70
|
| Rate for Payer: Cigna Commercial |
$18,379.17
|
| Rate for Payer: Health EOS Commercial |
$17,779.85
|
| Rate for Payer: HFN Commercial |
$18,379.17
|
| Rate for Payer: Multiplan Commercial |
$15,981.89
|
| Rate for Payer: Preferred Network Access Commercial |
$18,379.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,788.91
|
| Rate for Payer: Quartz Commercial |
$11,986.42
|
| Rate for Payer: WEA Trust Commercial |
$10,987.55
|
| Rate for Payer: WPS Commercial |
$14,796.69
|
|
|
Pioneer Catheter
|
Facility
|
OP
|
$19,209.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139311
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,593.66 |
| Max. Negotiated Rate |
$18,379.17 |
| Rate for Payer: Aetna Commercial |
$17,979.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,180.53
|
| Rate for Payer: Aetna Managed Medicare |
$5,593.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,985.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,988.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,589.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,588.00
|
| Rate for Payer: Cash Price |
$5,762.70
|
| Rate for Payer: Cigna Commercial |
$18,379.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,179.64
|
| Rate for Payer: Health EOS Commercial |
$17,779.85
|
| Rate for Payer: HFN Commercial |
$18,379.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,983.02
|
| Rate for Payer: Multiplan Commercial |
$15,981.89
|
| Rate for Payer: NAPHCARE Commercial |
$11,986.42
|
| Rate for Payer: Preferred Network Access Commercial |
$18,379.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,788.91
|
| Rate for Payer: Quartz Commercial |
$12,985.28
|
| Rate for Payer: Quartz Medicare Advantage |
$11,986.42
|
| Rate for Payer: The Alliance Commercial |
$9,988.68
|
| Rate for Payer: WEA Trust Commercial |
$10,987.55
|
| Rate for Payer: WPS Commercial |
$14,796.69
|
|
