|
SAW BLADE OXFORD KNEE RESECTION PROCEDURE 3 PACK 506298
|
Facility
|
OP
|
$7,181.00
|
|
| Hospital Charge Code |
4595635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,010.68 |
| Max. Negotiated Rate |
$28,724.00 |
| Rate for Payer: Aetna Commercial |
$6,462.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,175.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,010.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,667.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,590.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,446.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,805.93
|
| Rate for Payer: Cash Price |
$2,154.30
|
| Rate for Payer: Cigna Commercial |
$6,606.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,018.49
|
| Rate for Payer: Health EOS Commercial |
$6,391.09
|
| Rate for Payer: HFN Commercial |
$6,606.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,385.75
|
| Rate for Payer: Multiplan Commercial |
$5,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,308.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,606.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.69
|
| Rate for Payer: Quartz Commercial |
$4,667.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,308.60
|
| Rate for Payer: The Alliance Commercial |
$28,724.00
|
| Rate for Payer: WEA Trust Commercial |
$3,949.55
|
| Rate for Payer: WPS Commercial |
$5,318.97
|
|
|
SAW BLADE OXFORD KNEE RESECTION STRYKER HUB 506109
|
Facility
|
OP
|
$4,327.00
|
|
| Hospital Charge Code |
6181517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,211.56 |
| Max. Negotiated Rate |
$17,308.00 |
| Rate for Payer: Aetna Commercial |
$3,894.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,721.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,211.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,812.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,163.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,076.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,293.31
|
| Rate for Payer: Cash Price |
$1,298.10
|
| Rate for Payer: Cigna Commercial |
$3,980.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,421.39
|
| Rate for Payer: Health EOS Commercial |
$3,851.03
|
| Rate for Payer: HFN Commercial |
$3,980.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,245.25
|
| Rate for Payer: Multiplan Commercial |
$3,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,596.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,980.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,120.23
|
| Rate for Payer: Quartz Commercial |
$2,812.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,596.20
|
| Rate for Payer: The Alliance Commercial |
$17,308.00
|
| Rate for Payer: WEA Trust Commercial |
$2,379.85
|
| Rate for Payer: WPS Commercial |
$3,205.01
|
|
|
SAW BLADE OXFORD KNEE RESECTION STRYKER HUB 506109
|
Facility
|
IP
|
$4,327.00
|
|
| Hospital Charge Code |
6181517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,120.23 |
| Max. Negotiated Rate |
$3,980.84 |
| Rate for Payer: Aetna Commercial |
$3,894.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,721.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,293.31
|
| Rate for Payer: Cash Price |
$1,298.10
|
| Rate for Payer: Cigna Commercial |
$3,980.84
|
| Rate for Payer: Health EOS Commercial |
$3,851.03
|
| Rate for Payer: HFN Commercial |
$3,980.84
|
| Rate for Payer: Multiplan Commercial |
$3,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,596.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,980.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,120.23
|
| Rate for Payer: Quartz Commercial |
$2,596.20
|
| Rate for Payer: WEA Trust Commercial |
$2,379.85
|
| Rate for Payer: WPS Commercial |
$3,205.01
|
|
|
SCALENOTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960363
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SCALENOTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960363
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SCALPEL SAFETY DISPOSABLE STERILE #11
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
2963797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
SCALPEL SAFETY DISPOSABLE STERILE #11
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
2963797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.80
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
SCALPEL SAFETY DISPOSABLE STERILE 15
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
2963796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
SCALPEL SAFETY DISPOSABLE STERILE 15
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
2963796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.40
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
SCAN 3 AUDITORY ASSESSMENT
|
Facility
|
OP
|
$1,113.00
|
|
| Hospital Charge Code |
2972031
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$311.64 |
| Max. Negotiated Rate |
$4,452.00 |
| Rate for Payer: Aetna Commercial |
$1,001.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.18
|
| Rate for Payer: Aetna Managed Medicare |
$311.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$723.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$556.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.89
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,023.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.83
|
| Rate for Payer: Health EOS Commercial |
$990.57
|
| Rate for Payer: HFN Commercial |
$1,023.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$834.75
|
| Rate for Payer: Multiplan Commercial |
$890.40
|
| Rate for Payer: NAPHCARE Commercial |
$667.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.96
|
| Rate for Payer: Quartz Beloit One Network |
$545.37
|
| Rate for Payer: Quartz Commercial |
$723.45
|
| Rate for Payer: Quartz Medicare Advantage |
$667.80
|
| Rate for Payer: The Alliance Commercial |
$4,452.00
|
| Rate for Payer: WEA Trust Commercial |
$612.15
|
| Rate for Payer: WPS Commercial |
$824.40
|
|
|
SCAN 3 AUDITORY ASSESSMENT
|
Facility
|
IP
|
$1,113.00
|
|
| Hospital Charge Code |
2972031
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$545.37 |
| Max. Negotiated Rate |
$1,023.96 |
| Rate for Payer: Aetna Commercial |
$1,001.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.89
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,023.96
|
| Rate for Payer: Health EOS Commercial |
$990.57
|
| Rate for Payer: HFN Commercial |
$1,023.96
|
| Rate for Payer: Multiplan Commercial |
$890.40
|
| Rate for Payer: NAPHCARE Commercial |
$667.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.96
|
| Rate for Payer: Quartz Beloit One Network |
$545.37
|
| Rate for Payer: Quartz Commercial |
$667.80
|
| Rate for Payer: WEA Trust Commercial |
$612.15
|
| Rate for Payer: WPS Commercial |
$824.40
|
|
|
Scan Com Opth Diag 92134
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 92134
|
| Hospital Charge Code |
3568177
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.00
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: HFN Commercial |
$161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: The Alliance Commercial |
$85.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.08
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Scan Com Opth Diag 9213426
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 92134 26
|
| Hospital Charge Code |
3133525
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.00
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: HFN Commercial |
$161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.12
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: The Alliance Commercial |
$85.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.08
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Scan Comp Ophth Di Imag 92133
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 92133
|
| Hospital Charge Code |
3568176
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.60
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: HFN Commercial |
$157.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.59
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: The Alliance Commercial |
$83.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.08
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Scan Comp Ophth Di Imag 9213326
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 92133 26
|
| Hospital Charge Code |
3147525
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.60
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: HFN Commercial |
$157.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.15
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: The Alliance Commercial |
$83.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.08
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
SCAR REVISION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
SCAR REVISION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960364
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
SCHANZ PIN 5.0 TORNIER ZPSS5
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCHANZ PIN 5.0 TORNIER ZPSS5
|
Facility
|
OP
|
$1,281.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
Schistosoma Antibody (IgG), FMI
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.80
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: HFN Commercial |
$83.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Schistosoma Antibody (IgG), FMI
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Schistosoma Antibody (IgG), FMI
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SCISSOR 5MM HARMONIC ACE145
|
Facility
|
IP
|
$5,262.00
|
|
| Hospital Charge Code |
2969370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,578.38 |
| Max. Negotiated Rate |
$4,841.04 |
| Rate for Payer: Aetna Commercial |
$4,735.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,525.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.86
|
| Rate for Payer: Cash Price |
$1,578.60
|
| Rate for Payer: Cigna Commercial |
$4,841.04
|
| Rate for Payer: Health EOS Commercial |
$4,683.18
|
| Rate for Payer: HFN Commercial |
$4,841.04
|
| Rate for Payer: Multiplan Commercial |
$4,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.38
|
| Rate for Payer: Quartz Commercial |
$3,157.20
|
| Rate for Payer: WEA Trust Commercial |
$2,894.10
|
| Rate for Payer: WPS Commercial |
$3,897.56
|
|
|
SCISSOR 5MM HARMONIC ACE145
|
Facility
|
OP
|
$5,262.00
|
|
| Hospital Charge Code |
2969370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,473.36 |
| Max. Negotiated Rate |
$21,048.00 |
| Rate for Payer: Aetna Commercial |
$4,735.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,525.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,420.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,631.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,525.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.86
|
| Rate for Payer: Cash Price |
$1,578.60
|
| Rate for Payer: Cigna Commercial |
$4,841.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,944.62
|
| Rate for Payer: Health EOS Commercial |
$4,683.18
|
| Rate for Payer: HFN Commercial |
$4,841.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,946.50
|
| Rate for Payer: Multiplan Commercial |
$4,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.38
|
| Rate for Payer: Quartz Commercial |
$3,420.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,157.20
|
| Rate for Payer: The Alliance Commercial |
$21,048.00
|
| Rate for Payer: WEA Trust Commercial |
$2,894.10
|
| Rate for Payer: WPS Commercial |
$3,897.56
|
|
|
SCISSOR GRIP HARMONIC ACE 5mm ACE14S
|
Facility
|
OP
|
$5,910.00
|
|
| Hospital Charge Code |
2974014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$23,640.00 |
| Rate for Payer: Aetna Commercial |
$5,319.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,082.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,654.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,841.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,836.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,132.30
|
| Rate for Payer: Cash Price |
$1,773.00
|
| Rate for Payer: Cigna Commercial |
$5,437.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,307.24
|
| Rate for Payer: Health EOS Commercial |
$5,259.90
|
| Rate for Payer: HFN Commercial |
$5,437.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,432.50
|
| Rate for Payer: Multiplan Commercial |
$4,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,437.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,895.90
|
| Rate for Payer: Quartz Commercial |
$3,841.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.00
|
| Rate for Payer: The Alliance Commercial |
$23,640.00
|
| Rate for Payer: WEA Trust Commercial |
$3,250.50
|
| Rate for Payer: WPS Commercial |
$4,377.54
|
|
