|
PROSTATOLITHOTOMY
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2960324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,031.96 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$4,937.09
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
PROSTHESIS 20fr 14mm #IN2014IR
|
Facility
|
OP
|
$2,891.00
|
|
| Hospital Charge Code |
2973278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.86 |
| Max. Negotiated Rate |
$2,766.11 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Aetna Managed Medicare |
$841.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,954.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,503.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,443.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,682.56
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,254.98
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,803.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,954.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,803.98
|
| Rate for Payer: The Alliance Commercial |
$1,503.32
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
PROSTHESIS 20fr 14mm #IN2014IR
|
Facility
|
IP
|
$2,891.00
|
|
| Hospital Charge Code |
2973278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.25 |
| Max. Negotiated Rate |
$2,766.11 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,803.98
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
PROSTHESIS EAR 0.25M x 10MM
|
Facility
|
OP
|
$5,088.00
|
|
| Hospital Charge Code |
2965321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.63 |
| Max. Negotiated Rate |
$4,868.20 |
| Rate for Payer: Aetna Commercial |
$4,762.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,550.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,481.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,439.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,645.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,539.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,804.51
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Cigna Commercial |
$4,868.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,961.22
|
| Rate for Payer: Health EOS Commercial |
$4,709.45
|
| Rate for Payer: HFN Commercial |
$4,868.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,968.64
|
| Rate for Payer: Multiplan Commercial |
$4,233.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,174.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,868.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,592.84
|
| Rate for Payer: Quartz Commercial |
$3,439.49
|
| Rate for Payer: Quartz Medicare Advantage |
$3,174.91
|
| Rate for Payer: The Alliance Commercial |
$2,645.76
|
| Rate for Payer: WEA Trust Commercial |
$2,910.34
|
| Rate for Payer: WPS Commercial |
$3,919.29
|
|
|
PROSTHESIS EAR 0.25M x 10MM
|
Facility
|
IP
|
$5,088.00
|
|
| Hospital Charge Code |
2965321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.84 |
| Max. Negotiated Rate |
$4,868.20 |
| Rate for Payer: Aetna Commercial |
$4,762.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,550.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,804.51
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Cigna Commercial |
$4,868.20
|
| Rate for Payer: Health EOS Commercial |
$4,709.45
|
| Rate for Payer: HFN Commercial |
$4,868.20
|
| Rate for Payer: Multiplan Commercial |
$4,233.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,868.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,592.84
|
| Rate for Payer: Quartz Commercial |
$3,174.91
|
| Rate for Payer: WEA Trust Commercial |
$2,910.34
|
| Rate for Payer: WPS Commercial |
$3,919.29
|
|
|
PROSTHESIS EAR LIPPY
|
Facility
|
OP
|
$2,490.00
|
|
| Hospital Charge Code |
2965335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.09 |
| Max. Negotiated Rate |
$2,382.43 |
| Rate for Payer: Aetna Commercial |
$2,330.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,227.06
|
| Rate for Payer: Aetna Managed Medicare |
$725.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,683.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,243.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.49
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,382.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,449.18
|
| Rate for Payer: Health EOS Commercial |
$2,304.74
|
| Rate for Payer: HFN Commercial |
$2,382.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,942.20
|
| Rate for Payer: Multiplan Commercial |
$2,071.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,382.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.90
|
| Rate for Payer: Quartz Commercial |
$1,683.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.76
|
| Rate for Payer: The Alliance Commercial |
$1,294.80
|
| Rate for Payer: WEA Trust Commercial |
$1,424.28
|
| Rate for Payer: WPS Commercial |
$1,918.05
|
|
|
PROSTHESIS EAR LIPPY
|
Facility
|
IP
|
$2,490.00
|
|
| Hospital Charge Code |
2965335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.90 |
| Max. Negotiated Rate |
$2,382.43 |
| Rate for Payer: Aetna Commercial |
$2,330.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,227.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.49
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,382.43
|
| Rate for Payer: Health EOS Commercial |
$2,304.74
|
| Rate for Payer: HFN Commercial |
$2,382.43
|
| Rate for Payer: Multiplan Commercial |
$2,071.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,382.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.90
|
| Rate for Payer: Quartz Commercial |
$1,553.76
|
| Rate for Payer: WEA Trust Commercial |
$1,424.28
|
| Rate for Payer: WPS Commercial |
$1,918.05
|
|
|
PROSTHESIS EAR STAPES PISTON 1133005
|
Facility
|
IP
|
$2,318.00
|
|
| Hospital Charge Code |
2973976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,446.43
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
PROSTHESIS EAR STAPES PISTON 1133005
|
Facility
|
OP
|
$2,318.00
|
|
| Hospital Charge Code |
2973976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Aetna Managed Medicare |
$675.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,566.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,205.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.08
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,808.04
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,446.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,566.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,446.43
|
| Rate for Payer: The Alliance Commercial |
$1,205.36
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
PROSTHESIS EAR STAPES PISTON 1133007
|
Facility
|
IP
|
$2,318.00
|
|
| Hospital Charge Code |
2990960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,446.43
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
PROSTHESIS EAR STAPES PISTON 1133007
|
Facility
|
OP
|
$2,318.00
|
|
| Hospital Charge Code |
2990960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Aetna Managed Medicare |
$675.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,566.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,205.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.08
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,808.04
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,446.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,566.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,446.43
|
| Rate for Payer: The Alliance Commercial |
$1,205.36
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
PROSTHESIS VOICE DUAL 20fr 12mm #DV 2012-NS
|
Facility
|
OP
|
$4,442.00
|
|
| Hospital Charge Code |
2973516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,293.51 |
| Max. Negotiated Rate |
$4,250.11 |
| Rate for Payer: Aetna Commercial |
$4,157.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,972.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,293.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,002.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,309.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,217.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,448.43
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$4,250.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,585.24
|
| Rate for Payer: Health EOS Commercial |
$4,111.52
|
| Rate for Payer: HFN Commercial |
$4,250.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,464.76
|
| Rate for Payer: Multiplan Commercial |
$3,695.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,771.81
|
| Rate for Payer: Preferred Network Access Commercial |
$4,250.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,263.64
|
| Rate for Payer: Quartz Commercial |
$3,002.79
|
| Rate for Payer: Quartz Medicare Advantage |
$2,771.81
|
| Rate for Payer: The Alliance Commercial |
$2,309.84
|
| Rate for Payer: WEA Trust Commercial |
$2,540.82
|
| Rate for Payer: WPS Commercial |
$3,421.67
|
|
|
PROSTHESIS VOICE DUAL 20fr 12mm #DV 2012-NS
|
Facility
|
IP
|
$4,442.00
|
|
| Hospital Charge Code |
2973516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.64 |
| Max. Negotiated Rate |
$4,250.11 |
| Rate for Payer: Aetna Commercial |
$4,157.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,972.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,448.43
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$4,250.11
|
| Rate for Payer: Health EOS Commercial |
$4,111.52
|
| Rate for Payer: HFN Commercial |
$4,250.11
|
| Rate for Payer: Multiplan Commercial |
$3,695.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,250.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,263.64
|
| Rate for Payer: Quartz Commercial |
$2,771.81
|
| Rate for Payer: WEA Trust Commercial |
$2,540.82
|
| Rate for Payer: WPS Commercial |
$3,421.67
|
|
|
PROSTHESIS VOICE INDWELLING 20fr 12mm #IN 2012IR
|
Facility
|
IP
|
$2,780.00
|
|
| Hospital Charge Code |
2973256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.69 |
| Max. Negotiated Rate |
$2,659.90 |
| Rate for Payer: Aetna Commercial |
$2,602.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.34
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,659.90
|
| Rate for Payer: Health EOS Commercial |
$2,573.17
|
| Rate for Payer: HFN Commercial |
$2,659.90
|
| Rate for Payer: Multiplan Commercial |
$2,312.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.69
|
| Rate for Payer: Quartz Commercial |
$1,734.72
|
| Rate for Payer: WEA Trust Commercial |
$1,590.16
|
| Rate for Payer: WPS Commercial |
$2,141.43
|
|
|
PROSTHESIS VOICE INDWELLING 20fr 12mm #IN 2012IR
|
Facility
|
OP
|
$2,780.00
|
|
| Hospital Charge Code |
2973256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.54 |
| Max. Negotiated Rate |
$2,659.90 |
| Rate for Payer: Aetna Commercial |
$2,602.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.43
|
| Rate for Payer: Aetna Managed Medicare |
$809.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,879.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.34
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,659.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,617.96
|
| Rate for Payer: Health EOS Commercial |
$2,573.17
|
| Rate for Payer: HFN Commercial |
$2,659.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,168.40
|
| Rate for Payer: Multiplan Commercial |
$2,312.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.69
|
| Rate for Payer: Quartz Commercial |
$1,879.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,734.72
|
| Rate for Payer: The Alliance Commercial |
$1,445.60
|
| Rate for Payer: WEA Trust Commercial |
$1,590.16
|
| Rate for Payer: WPS Commercial |
$2,141.43
|
|
|
PROSTHESIS VOICE INDWELLING 20FR 6mm #IN 2006-NS
|
Facility
|
OP
|
$2,869.00
|
|
| Hospital Charge Code |
2973134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$835.45 |
| Max. Negotiated Rate |
$2,745.06 |
| Rate for Payer: Aetna Commercial |
$2,685.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.03
|
| Rate for Payer: Aetna Managed Medicare |
$835.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,939.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,432.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.39
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,745.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.76
|
| Rate for Payer: Health EOS Commercial |
$2,655.55
|
| Rate for Payer: HFN Commercial |
$2,745.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,237.82
|
| Rate for Payer: Multiplan Commercial |
$2,387.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,790.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.04
|
| Rate for Payer: Quartz Commercial |
$1,939.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,790.26
|
| Rate for Payer: The Alliance Commercial |
$1,491.88
|
| Rate for Payer: WEA Trust Commercial |
$1,641.07
|
| Rate for Payer: WPS Commercial |
$2,209.99
|
|
|
PROSTHESIS VOICE INDWELLING 20FR 6mm #IN 2006-NS
|
Facility
|
IP
|
$2,869.00
|
|
| Hospital Charge Code |
2973134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.04 |
| Max. Negotiated Rate |
$2,745.06 |
| Rate for Payer: Aetna Commercial |
$2,685.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.39
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,745.06
|
| Rate for Payer: Health EOS Commercial |
$2,655.55
|
| Rate for Payer: HFN Commercial |
$2,745.06
|
| Rate for Payer: Multiplan Commercial |
$2,387.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.04
|
| Rate for Payer: Quartz Commercial |
$1,790.26
|
| Rate for Payer: WEA Trust Commercial |
$1,641.07
|
| Rate for Payer: WPS Commercial |
$2,209.99
|
|
|
PROSTHESIS VOICE INDWELLING 20fr 8mm #IN 2008-IR
|
Facility
|
OP
|
$2,780.00
|
|
| Hospital Charge Code |
2973255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.54 |
| Max. Negotiated Rate |
$2,659.90 |
| Rate for Payer: Aetna Commercial |
$2,602.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.43
|
| Rate for Payer: Aetna Managed Medicare |
$809.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,879.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.34
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,659.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,617.96
|
| Rate for Payer: Health EOS Commercial |
$2,573.17
|
| Rate for Payer: HFN Commercial |
$2,659.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,168.40
|
| Rate for Payer: Multiplan Commercial |
$2,312.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.69
|
| Rate for Payer: Quartz Commercial |
$1,879.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,734.72
|
| Rate for Payer: The Alliance Commercial |
$1,445.60
|
| Rate for Payer: WEA Trust Commercial |
$1,590.16
|
| Rate for Payer: WPS Commercial |
$2,141.43
|
|
|
PROSTHESIS VOICE INDWELLING 20fr 8mm #IN 2008-IR
|
Facility
|
IP
|
$2,780.00
|
|
| Hospital Charge Code |
2973255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.69 |
| Max. Negotiated Rate |
$2,659.90 |
| Rate for Payer: Aetna Commercial |
$2,602.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.34
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,659.90
|
| Rate for Payer: Health EOS Commercial |
$2,573.17
|
| Rate for Payer: HFN Commercial |
$2,659.90
|
| Rate for Payer: Multiplan Commercial |
$2,312.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.69
|
| Rate for Payer: Quartz Commercial |
$1,734.72
|
| Rate for Payer: WEA Trust Commercial |
$1,590.16
|
| Rate for Payer: WPS Commercial |
$2,141.43
|
|
|
PROSTHESIS VOICE INDWELLING 20FR 8mm #IN 2008-NS
|
Facility
|
IP
|
$2,869.00
|
|
| Hospital Charge Code |
2973135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.04 |
| Max. Negotiated Rate |
$2,745.06 |
| Rate for Payer: Aetna Commercial |
$2,685.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.39
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,745.06
|
| Rate for Payer: Health EOS Commercial |
$2,655.55
|
| Rate for Payer: HFN Commercial |
$2,745.06
|
| Rate for Payer: Multiplan Commercial |
$2,387.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.04
|
| Rate for Payer: Quartz Commercial |
$1,790.26
|
| Rate for Payer: WEA Trust Commercial |
$1,641.07
|
| Rate for Payer: WPS Commercial |
$2,209.99
|
|
|
PROSTHESIS VOICE INDWELLING 20FR 8mm #IN 2008-NS
|
Facility
|
OP
|
$2,869.00
|
|
| Hospital Charge Code |
2973135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$835.45 |
| Max. Negotiated Rate |
$2,745.06 |
| Rate for Payer: Aetna Commercial |
$2,685.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.03
|
| Rate for Payer: Aetna Managed Medicare |
$835.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,939.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,432.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.39
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,745.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.76
|
| Rate for Payer: Health EOS Commercial |
$2,655.55
|
| Rate for Payer: HFN Commercial |
$2,745.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,237.82
|
| Rate for Payer: Multiplan Commercial |
$2,387.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,790.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.04
|
| Rate for Payer: Quartz Commercial |
$1,939.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,790.26
|
| Rate for Payer: The Alliance Commercial |
$1,491.88
|
| Rate for Payer: WEA Trust Commercial |
$1,641.07
|
| Rate for Payer: WPS Commercial |
$2,209.99
|
|
|
Protamine Sulfate 50mg/5ml vial [Med]
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
2974976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Protamine Sulfate 50mg/5ml vial [Med]
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
2974976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.93
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$6.53
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$5.53
|
|
|
PROTECTIVE TIP CAP 3MM BROWN 5047-1-030
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
6165644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.22 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$125.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.40
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$268.32
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$268.32
|
| Rate for Payer: The Alliance Commercial |
$223.60
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
PROTECTIVE TIP CAP 3MM BROWN 5047-1-030
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
6165644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
