|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT RT 02.111.740
|
Facility
|
IP
|
$6,729.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,429.10 |
| Max. Negotiated Rate |
$6,438.31 |
| Rate for Payer: Aetna Commercial |
$6,298.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,018.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,709.02
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cigna Commercial |
$6,438.31
|
| Rate for Payer: Health EOS Commercial |
$6,228.36
|
| Rate for Payer: HFN Commercial |
$6,438.31
|
| Rate for Payer: Multiplan Commercial |
$5,598.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,438.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,429.10
|
| Rate for Payer: Quartz Commercial |
$4,198.90
|
| Rate for Payer: WEA Trust Commercial |
$3,848.99
|
| Rate for Payer: WPS Commercial |
$5,183.35
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/5HL SHAFT RT 02.111.750
|
Facility
|
OP
|
$5,195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3945322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.78 |
| Max. Negotiated Rate |
$4,970.58 |
| Rate for Payer: Aetna Commercial |
$4,862.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,646.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,512.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,511.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,701.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,593.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,863.48
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cigna Commercial |
$4,970.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,023.49
|
| Rate for Payer: Health EOS Commercial |
$4,808.49
|
| Rate for Payer: HFN Commercial |
$4,970.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,052.10
|
| Rate for Payer: Multiplan Commercial |
$4,322.24
|
| Rate for Payer: NAPHCARE Commercial |
$3,241.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,970.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,647.37
|
| Rate for Payer: Quartz Commercial |
$3,511.82
|
| Rate for Payer: Quartz Medicare Advantage |
$3,241.68
|
| Rate for Payer: The Alliance Commercial |
$2,701.40
|
| Rate for Payer: WEA Trust Commercial |
$2,971.54
|
| Rate for Payer: WPS Commercial |
$4,001.71
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/5HL SHAFT RT 02.111.750
|
Facility
|
IP
|
$5,195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3945322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.37 |
| Max. Negotiated Rate |
$4,970.58 |
| Rate for Payer: Aetna Commercial |
$4,862.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,646.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,863.48
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cigna Commercial |
$4,970.58
|
| Rate for Payer: Health EOS Commercial |
$4,808.49
|
| Rate for Payer: HFN Commercial |
$4,970.58
|
| Rate for Payer: Multiplan Commercial |
$4,322.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,970.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,647.37
|
| Rate for Payer: Quartz Commercial |
$3,241.68
|
| Rate for Payer: WEA Trust Commercial |
$2,971.54
|
| Rate for Payer: WPS Commercial |
$4,001.71
|
|
|
PLATE VOLAR DISTAL RADIUS 7HL 02.110.107
|
Facility
|
IP
|
$10,770.00
|
|
| Hospital Charge Code |
2966356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,488.39 |
| Max. Negotiated Rate |
$10,304.74 |
| Rate for Payer: Aetna Commercial |
$10,080.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,632.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,936.42
|
| Rate for Payer: Cash Price |
$3,231.00
|
| Rate for Payer: Cigna Commercial |
$10,304.74
|
| Rate for Payer: Health EOS Commercial |
$9,968.71
|
| Rate for Payer: HFN Commercial |
$10,304.74
|
| Rate for Payer: Multiplan Commercial |
$8,960.64
|
| Rate for Payer: Preferred Network Access Commercial |
$10,304.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.39
|
| Rate for Payer: Quartz Commercial |
$6,720.48
|
| Rate for Payer: WEA Trust Commercial |
$6,160.44
|
| Rate for Payer: WPS Commercial |
$8,296.13
|
|
|
PLATE VOLAR DISTAL RADIUS 7HL 02.110.107
|
Facility
|
OP
|
$10,770.00
|
|
| Hospital Charge Code |
2966356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,136.22 |
| Max. Negotiated Rate |
$10,304.74 |
| Rate for Payer: Aetna Commercial |
$10,080.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,632.69
|
| Rate for Payer: Aetna Managed Medicare |
$3,136.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,280.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,600.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,376.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,936.42
|
| Rate for Payer: Cash Price |
$3,231.00
|
| Rate for Payer: Cigna Commercial |
$10,304.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,268.14
|
| Rate for Payer: Health EOS Commercial |
$9,968.71
|
| Rate for Payer: HFN Commercial |
$10,304.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,400.60
|
| Rate for Payer: Multiplan Commercial |
$8,960.64
|
| Rate for Payer: NAPHCARE Commercial |
$6,720.48
|
| Rate for Payer: Preferred Network Access Commercial |
$10,304.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.39
|
| Rate for Payer: Quartz Commercial |
$7,280.52
|
| Rate for Payer: Quartz Medicare Advantage |
$6,720.48
|
| Rate for Payer: The Alliance Commercial |
$5,600.40
|
| Rate for Payer: WEA Trust Commercial |
$6,160.44
|
| Rate for Payer: WPS Commercial |
$8,296.13
|
|
|
PLATE WAVE CALCANEAL MED TORNIER ZPML
|
Facility
|
OP
|
$7,780.00
|
|
| Hospital Charge Code |
2967359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.54 |
| Max. Negotiated Rate |
$7,443.90 |
| Rate for Payer: Aetna Commercial |
$7,282.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,958.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,265.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,259.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,045.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,883.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,288.34
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,443.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,527.96
|
| Rate for Payer: Health EOS Commercial |
$7,201.17
|
| Rate for Payer: HFN Commercial |
$7,443.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,068.40
|
| Rate for Payer: Multiplan Commercial |
$6,472.96
|
| Rate for Payer: NAPHCARE Commercial |
$4,854.72
|
| Rate for Payer: Preferred Network Access Commercial |
$7,443.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,964.69
|
| Rate for Payer: Quartz Commercial |
$5,259.28
|
| Rate for Payer: Quartz Medicare Advantage |
$4,854.72
|
| Rate for Payer: The Alliance Commercial |
$4,045.60
|
| Rate for Payer: WEA Trust Commercial |
$4,450.16
|
| Rate for Payer: WPS Commercial |
$5,992.93
|
|
|
PLATE WAVE CALCANEAL MED TORNIER ZPML
|
Facility
|
IP
|
$7,780.00
|
|
| Hospital Charge Code |
2967359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,964.69 |
| Max. Negotiated Rate |
$7,443.90 |
| Rate for Payer: Aetna Commercial |
$7,282.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,958.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,288.34
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,443.90
|
| Rate for Payer: Health EOS Commercial |
$7,201.17
|
| Rate for Payer: HFN Commercial |
$7,443.90
|
| Rate for Payer: Multiplan Commercial |
$6,472.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,443.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,964.69
|
| Rate for Payer: Quartz Commercial |
$4,854.72
|
| Rate for Payer: WEA Trust Commercial |
$4,450.16
|
| Rate for Payer: WPS Commercial |
$5,992.93
|
|
|
PLATE WIDE 12HL BIOMET 73-2634
|
Facility
|
OP
|
$4,584.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.86 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,334.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,098.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,383.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,288.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,667.89
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,575.52
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: NAPHCARE Commercial |
$2,860.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$3,098.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,860.42
|
| Rate for Payer: The Alliance Commercial |
$2,383.68
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
PLATE WIDE 12HL BIOMET 73-2634
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,336.01 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$2,860.42
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
PLATE WRIST FUSION SHORT BEND 629589
|
Facility
|
IP
|
$6,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,436.23 |
| Max. Negotiated Rate |
$6,451.70 |
| Rate for Payer: Aetna Commercial |
$6,311.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,030.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,716.74
|
| Rate for Payer: Cash Price |
$2,022.90
|
| Rate for Payer: Cigna Commercial |
$6,451.70
|
| Rate for Payer: Health EOS Commercial |
$6,241.32
|
| Rate for Payer: HFN Commercial |
$6,451.70
|
| Rate for Payer: Multiplan Commercial |
$5,610.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,451.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,436.23
|
| Rate for Payer: Quartz Commercial |
$4,207.63
|
| Rate for Payer: WEA Trust Commercial |
$3,857.00
|
| Rate for Payer: WPS Commercial |
$5,194.13
|
|
|
PLATE WRIST FUSION SHORT BEND 629589
|
Facility
|
OP
|
$6,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.56 |
| Max. Negotiated Rate |
$6,451.70 |
| Rate for Payer: Aetna Commercial |
$6,311.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,030.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,963.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,558.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,506.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,366.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,716.74
|
| Rate for Payer: Cash Price |
$2,022.90
|
| Rate for Payer: Cigna Commercial |
$6,451.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,924.43
|
| Rate for Payer: Health EOS Commercial |
$6,241.32
|
| Rate for Payer: HFN Commercial |
$6,451.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,259.54
|
| Rate for Payer: Multiplan Commercial |
$5,610.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,207.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,451.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,436.23
|
| Rate for Payer: Quartz Commercial |
$4,558.27
|
| Rate for Payer: Quartz Medicare Advantage |
$4,207.63
|
| Rate for Payer: The Alliance Commercial |
$3,506.36
|
| Rate for Payer: WEA Trust Commercial |
$3,857.00
|
| Rate for Payer: WPS Commercial |
$5,194.13
|
|
|
PLATE WRIST FUSION STD BEND 629579
|
Facility
|
IP
|
$6,483.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,304.02 |
| Max. Negotiated Rate |
$6,203.46 |
| Rate for Payer: Aetna Commercial |
$6,068.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,798.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,573.73
|
| Rate for Payer: Cash Price |
$1,945.07
|
| Rate for Payer: Cigna Commercial |
$6,203.46
|
| Rate for Payer: Health EOS Commercial |
$6,001.17
|
| Rate for Payer: HFN Commercial |
$6,203.46
|
| Rate for Payer: Multiplan Commercial |
$5,394.31
|
| Rate for Payer: Preferred Network Access Commercial |
$6,203.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,304.02
|
| Rate for Payer: Quartz Commercial |
$4,045.74
|
| Rate for Payer: WEA Trust Commercial |
$3,708.59
|
| Rate for Payer: WPS Commercial |
$4,994.28
|
|
|
PLATE WRIST FUSION STD BEND 629579
|
Facility
|
OP
|
$6,483.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,888.01 |
| Max. Negotiated Rate |
$6,203.46 |
| Rate for Payer: Aetna Commercial |
$6,068.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,798.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,888.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,382.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,371.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,236.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,573.73
|
| Rate for Payer: Cash Price |
$1,945.07
|
| Rate for Payer: Cigna Commercial |
$6,203.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,773.43
|
| Rate for Payer: Health EOS Commercial |
$6,001.17
|
| Rate for Payer: HFN Commercial |
$6,203.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,057.17
|
| Rate for Payer: Multiplan Commercial |
$5,394.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,045.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,203.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,304.02
|
| Rate for Payer: Quartz Commercial |
$4,382.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,045.74
|
| Rate for Payer: The Alliance Commercial |
$3,371.45
|
| Rate for Payer: WEA Trust Commercial |
$3,708.59
|
| Rate for Payer: WPS Commercial |
$4,994.28
|
|
|
PLEDGETS FELT PTFE 4.5MM X 6MM 1.65 007970
|
Facility
|
IP
|
$467.00
|
|
| Hospital Charge Code |
2974001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.98 |
| Max. Negotiated Rate |
$446.83 |
| Rate for Payer: Aetna Commercial |
$437.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.41
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$446.83
|
| Rate for Payer: Health EOS Commercial |
$432.26
|
| Rate for Payer: HFN Commercial |
$446.83
|
| Rate for Payer: Multiplan Commercial |
$388.54
|
| Rate for Payer: Preferred Network Access Commercial |
$446.83
|
| Rate for Payer: Quartz Beloit One Network |
$237.98
|
| Rate for Payer: Quartz Commercial |
$291.41
|
| Rate for Payer: WEA Trust Commercial |
$267.12
|
| Rate for Payer: WPS Commercial |
$359.73
|
|
|
PLEDGETS FELT PTFE 4.5MM X 6MM 1.65 007970
|
Facility
|
OP
|
$467.00
|
|
| Hospital Charge Code |
2974001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.99 |
| Max. Negotiated Rate |
$446.83 |
| Rate for Payer: Aetna Commercial |
$437.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.68
|
| Rate for Payer: Aetna Managed Medicare |
$135.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.41
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$446.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.79
|
| Rate for Payer: Health EOS Commercial |
$432.26
|
| Rate for Payer: HFN Commercial |
$446.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.26
|
| Rate for Payer: Multiplan Commercial |
$388.54
|
| Rate for Payer: NAPHCARE Commercial |
$291.41
|
| Rate for Payer: Preferred Network Access Commercial |
$446.83
|
| Rate for Payer: Quartz Beloit One Network |
$237.98
|
| Rate for Payer: Quartz Commercial |
$315.69
|
| Rate for Payer: Quartz Medicare Advantage |
$291.41
|
| Rate for Payer: The Alliance Commercial |
$242.84
|
| Rate for Payer: WEA Trust Commercial |
$267.12
|
| Rate for Payer: WPS Commercial |
$359.73
|
|
|
Pleural Cath
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$921.87 |
| Max. Negotiated Rate |
$1,730.85 |
| Rate for Payer: Aetna Commercial |
$1,693.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.12
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,730.85
|
| Rate for Payer: Health EOS Commercial |
$1,674.41
|
| Rate for Payer: HFN Commercial |
$1,730.85
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,730.85
|
| Rate for Payer: Quartz Beloit One Network |
$921.87
|
| Rate for Payer: Quartz Commercial |
$1,128.82
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
Pleural Cath
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,730.85 |
| Rate for Payer: Aetna Commercial |
$1,693.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Aetna Managed Medicare |
$526.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,222.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$940.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.12
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,730.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,052.84
|
| Rate for Payer: Health EOS Commercial |
$1,674.41
|
| Rate for Payer: HFN Commercial |
$1,730.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.02
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,128.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,730.85
|
| Rate for Payer: Quartz Beloit One Network |
$921.87
|
| Rate for Payer: Quartz Commercial |
$1,222.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,128.82
|
| Rate for Payer: The Alliance Commercial |
$940.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
Pleural Cath
|
Professional
|
Both
|
$1,809.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$827.80 |
| Max. Negotiated Rate |
$1,787.29 |
| Rate for Payer: Aetna Commercial |
$1,787.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,787.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$940.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,128.82
|
| Rate for Payer: Health EOS Commercial |
$1,712.04
|
| Rate for Payer: HFN Commercial |
$1,787.29
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,787.29
|
| Rate for Payer: Quartz Beloit One Network |
$827.80
|
| Rate for Payer: Quartz Commercial |
$1,072.38
|
| Rate for Payer: The Alliance Commercial |
$940.68
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$27,880.32
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$8,081.49 |
| Max. Negotiated Rate |
$27,880.32 |
| Rate for Payer: Aetna Managed Medicare |
$8,081.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,581.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,541.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,715.93
|
| Rate for Payer: Anthem Medicare Advantage |
$8,081.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,081.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,081.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,081.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,446.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,081.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,204.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,081.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,081.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,081.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,081.49
|
| Rate for Payer: NAPHCARE Commercial |
$12,122.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8,081.49
|
| Rate for Payer: The Alliance Commercial |
$27,880.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,081.49
|
| Rate for Payer: United Healthcare PPO |
$15,729.82
|
| Rate for Payer: Wellcare Medicare |
$8,081.49
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$43,247.36
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$12,442.09 |
| Max. Negotiated Rate |
$43,247.36 |
| Rate for Payer: Aetna Managed Medicare |
$12,442.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,005.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,064.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,763.19
|
| Rate for Payer: Anthem Medicare Advantage |
$12,442.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,442.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,442.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,442.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,489.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,442.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,476.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,442.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,442.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,442.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,442.09
|
| Rate for Payer: NAPHCARE Commercial |
$18,663.14
|
| Rate for Payer: Quartz Medicare Advantage |
$12,442.09
|
| Rate for Payer: The Alliance Commercial |
$43,247.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,442.09
|
| Rate for Payer: United Healthcare PPO |
$24,504.93
|
| Rate for Payer: Wellcare Medicare |
$12,442.09
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$20,973.68
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$5,999.24 |
| Max. Negotiated Rate |
$20,973.68 |
| Rate for Payer: Aetna Managed Medicare |
$5,999.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,648.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,994.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,395.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,999.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,999.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,999.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,999.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,650.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,999.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,139.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,999.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,999.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,999.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,999.24
|
| Rate for Payer: NAPHCARE Commercial |
$8,998.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5,999.24
|
| Rate for Payer: The Alliance Commercial |
$20,973.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,999.24
|
| Rate for Payer: United Healthcare PPO |
$11,785.92
|
| Rate for Payer: Wellcare Medicare |
$5,999.24
|
|
|
PleurX Catheter Removal
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
5364744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: Aetna Commercial |
$955.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$142.56
|
| Rate for Payer: Anthem Medicare Advantage |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.56
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.56
|
| Rate for Payer: Health EOS Commercial |
$915.17
|
| Rate for Payer: HFN Commercial |
$955.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.56
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$213.84
|
| Rate for Payer: Preferred Network Access Commercial |
$955.40
|
| Rate for Payer: Quartz Beloit One Network |
$442.50
|
| Rate for Payer: Quartz Commercial |
$573.24
|
| Rate for Payer: Quartz Medicare Advantage |
$142.56
|
| Rate for Payer: The Alliance Commercial |
$605.89
|
| Rate for Payer: United Healthcare Medicaid |
$154.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.56
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$641.53
|
|
|
PleurX Catheter Removal
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
5364744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$905.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$502.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.73
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$925.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$895.06
|
| Rate for Payer: HFN Commercial |
$925.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$925.23
|
| Rate for Payer: Quartz Beloit One Network |
$492.78
|
| Rate for Payer: Quartz Commercial |
$653.69
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$744.88
|
|
|
PleurX Catheter Removal
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
5364744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$492.78 |
| Max. Negotiated Rate |
$925.23 |
| Rate for Payer: Aetna Commercial |
$905.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.01
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$925.23
|
| Rate for Payer: Health EOS Commercial |
$895.06
|
| Rate for Payer: HFN Commercial |
$925.23
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: Preferred Network Access Commercial |
$925.23
|
| Rate for Payer: Quartz Beloit One Network |
$492.78
|
| Rate for Payer: Quartz Commercial |
$603.41
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$744.88
|
|
|
PLUG ANAL FISTULA SURGISIS 0.6 X 9.5 G53614
|
Facility
|
IP
|
$6,553.00
|
|
| Hospital Charge Code |
5307117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,339.41 |
| Max. Negotiated Rate |
$6,269.91 |
| Rate for Payer: Aetna Commercial |
$6,133.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,612.01
|
| Rate for Payer: Cash Price |
$1,965.90
|
| Rate for Payer: Cigna Commercial |
$6,269.91
|
| Rate for Payer: Health EOS Commercial |
$6,065.46
|
| Rate for Payer: HFN Commercial |
$6,269.91
|
| Rate for Payer: Multiplan Commercial |
$5,452.10
|
| Rate for Payer: Preferred Network Access Commercial |
$6,269.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,339.41
|
| Rate for Payer: Quartz Commercial |
$4,089.07
|
| Rate for Payer: WEA Trust Commercial |
$3,748.32
|
| Rate for Payer: WPS Commercial |
$5,047.78
|
|
