|
PILONIDAL CYSTECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
PIN BALL JURGAN .035 W035-DB
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2965215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
PIN BALL JURGAN .035 W035-DB
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2965215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
PIN BALL JURGAN .045 W045-YL
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2965216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
PIN BALL JURGAN .045 W045-YL
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2965216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
PIN BALL JURGAN .062 W062-GN
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2965217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
PIN BALL JURGAN .062 W062-GN
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2965217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
PIN BALL JURGAN 3/32 W332-CR
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL JURGAN 3/32 W332-CR
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 3MM X003
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 3MM X003
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 4MM X004
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 4MM X004
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 5MM X005
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 5MM X005
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 6MM X006
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 6MM X006
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BAYONETTE 18 WITH EYELET 219382"
|
Facility
|
IP
|
$3,005.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,531.35 |
| Max. Negotiated Rate |
$2,875.18 |
| Rate for Payer: Aetna Commercial |
$2,812.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,687.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,656.36
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$2,875.18
|
| Rate for Payer: Health EOS Commercial |
$2,781.43
|
| Rate for Payer: HFN Commercial |
$2,875.18
|
| Rate for Payer: Multiplan Commercial |
$2,500.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,875.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,531.35
|
| Rate for Payer: Quartz Commercial |
$1,875.12
|
| Rate for Payer: WEA Trust Commercial |
$1,718.86
|
| Rate for Payer: WPS Commercial |
$2,314.75
|
|
|
PIN BAYONETTE 18 WITH EYELET 219382"
|
Facility
|
OP
|
$3,005.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$875.06 |
| Max. Negotiated Rate |
$2,875.18 |
| Rate for Payer: Aetna Commercial |
$2,812.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,687.67
|
| Rate for Payer: Aetna Managed Medicare |
$875.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,031.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,562.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,500.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,656.36
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$2,875.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,748.91
|
| Rate for Payer: Health EOS Commercial |
$2,781.43
|
| Rate for Payer: HFN Commercial |
$2,875.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,343.90
|
| Rate for Payer: Multiplan Commercial |
$2,500.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,875.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,875.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,531.35
|
| Rate for Payer: Quartz Commercial |
$2,031.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,875.12
|
| Rate for Payer: The Alliance Commercial |
$1,562.60
|
| Rate for Payer: WEA Trust Commercial |
$1,718.86
|
| Rate for Payer: WPS Commercial |
$2,314.75
|
|
|
PIN BUTRESS 1.8 X 12 200.190
|
Facility
|
OP
|
$1,838.00
|
|
| Hospital Charge Code |
2966307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.23 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Aetna Commercial |
$1,720.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,643.91
|
| Rate for Payer: Aetna Managed Medicare |
$535.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,242.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$955.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$917.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.11
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$1,758.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,069.72
|
| Rate for Payer: Health EOS Commercial |
$1,701.25
|
| Rate for Payer: HFN Commercial |
$1,758.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,433.64
|
| Rate for Payer: Multiplan Commercial |
$1,529.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,146.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.60
|
| Rate for Payer: Quartz Beloit One Network |
$936.64
|
| Rate for Payer: Quartz Commercial |
$1,242.49
|
| Rate for Payer: Quartz Medicare Advantage |
$1,146.91
|
| Rate for Payer: The Alliance Commercial |
$955.76
|
| Rate for Payer: WEA Trust Commercial |
$1,051.34
|
| Rate for Payer: WPS Commercial |
$1,415.81
|
|
|
PIN BUTRESS 1.8 X 12 200.190
|
Facility
|
IP
|
$1,838.00
|
|
| Hospital Charge Code |
2966307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.64 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Aetna Commercial |
$1,720.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,643.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.11
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$1,758.60
|
| Rate for Payer: Health EOS Commercial |
$1,701.25
|
| Rate for Payer: HFN Commercial |
$1,758.60
|
| Rate for Payer: Multiplan Commercial |
$1,529.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.60
|
| Rate for Payer: Quartz Beloit One Network |
$936.64
|
| Rate for Payer: Quartz Commercial |
$1,146.91
|
| Rate for Payer: WEA Trust Commercial |
$1,051.34
|
| Rate for Payer: WPS Commercial |
$1,415.81
|
|
|
PIN BUTRESS 1.8 X 20 200.194
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2966308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
PIN BUTRESS 1.8 X 20 200.194
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2966308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Aetna Managed Medicare |
$509.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,018.50
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.00
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,183.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.00
|
| Rate for Payer: The Alliance Commercial |
$910.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
PIN CLAMP 6-POSITION 390.010
|
Facility
|
IP
|
$4,262.00
|
|
| Hospital Charge Code |
4632639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,171.92 |
| Max. Negotiated Rate |
$4,077.88 |
| Rate for Payer: Aetna Commercial |
$3,989.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,811.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,349.21
|
| Rate for Payer: Cash Price |
$1,278.60
|
| Rate for Payer: Cigna Commercial |
$4,077.88
|
| Rate for Payer: Health EOS Commercial |
$3,944.91
|
| Rate for Payer: HFN Commercial |
$4,077.88
|
| Rate for Payer: Multiplan Commercial |
$3,545.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,077.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,171.92
|
| Rate for Payer: Quartz Commercial |
$2,659.49
|
| Rate for Payer: WEA Trust Commercial |
$2,437.86
|
| Rate for Payer: WPS Commercial |
$3,283.02
|
|
|
PIN CLAMP 6-POSITION 390.010
|
Facility
|
OP
|
$4,262.00
|
|
| Hospital Charge Code |
4632639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,241.09 |
| Max. Negotiated Rate |
$4,077.88 |
| Rate for Payer: Aetna Commercial |
$3,989.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,811.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,881.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,216.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,127.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,349.21
|
| Rate for Payer: Cash Price |
$1,278.60
|
| Rate for Payer: Cigna Commercial |
$4,077.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,480.48
|
| Rate for Payer: Health EOS Commercial |
$3,944.91
|
| Rate for Payer: HFN Commercial |
$4,077.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,324.36
|
| Rate for Payer: Multiplan Commercial |
$3,545.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,659.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,077.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,171.92
|
| Rate for Payer: Quartz Commercial |
$2,881.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,659.49
|
| Rate for Payer: The Alliance Commercial |
$2,216.24
|
| Rate for Payer: WEA Trust Commercial |
$2,437.86
|
| Rate for Payer: WPS Commercial |
$3,283.02
|
|
