|
RBC CPD AS5 500 LR Irr
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052833
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.05
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$442.26
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
RBC CPD AS5 LV
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052835
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 LV
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052835
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC Deglyc
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
1052819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$399.02 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$488.59
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
RBC Deglyc
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
1052819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$273.17 |
| Max. Negotiated Rate |
$1,092.67 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Aetna Managed Medicare |
$273.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.87
|
| Rate for Payer: Anthem Medicare Advantage |
$273.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$273.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$273.17
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$273.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$273.17
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$273.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$273.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$273.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$273.17
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: NAPHCARE Commercial |
$409.75
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$529.31
|
| Rate for Payer: Quartz Medicare Advantage |
$273.17
|
| Rate for Payer: The Alliance Commercial |
$1,092.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.17
|
| Rate for Payer: United Healthcare PPO |
$610.74
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: Wellcare Medicare |
$273.17
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
RBC LR Washed
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052864
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$750.13 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$918.53
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
RBC LR Washed
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052864
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$379.66 |
| Max. Negotiated Rate |
$1,518.65 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Aetna Managed Medicare |
$379.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.82
|
| Rate for Payer: Anthem Medicare Advantage |
$379.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.66
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$379.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$379.66
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,412.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$379.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$379.66
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$569.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$995.07
|
| Rate for Payer: Quartz Medicare Advantage |
$379.66
|
| Rate for Payer: The Alliance Commercial |
$1,518.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.66
|
| Rate for Payer: United Healthcare PPO |
$1,148.16
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: Wellcare Medicare |
$379.66
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
RBC Washed
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$750.13 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$918.53
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
RBC Washed
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$379.66 |
| Max. Negotiated Rate |
$1,518.65 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Aetna Managed Medicare |
$379.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.82
|
| Rate for Payer: Anthem Medicare Advantage |
$379.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.66
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$379.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$379.66
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,412.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$379.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$379.66
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$569.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$995.07
|
| Rate for Payer: Quartz Medicare Advantage |
$379.66
|
| Rate for Payer: The Alliance Commercial |
$1,518.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.66
|
| Rate for Payer: United Healthcare PPO |
$1,148.16
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: Wellcare Medicare |
$379.66
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
REACHER 26 6 OZ. #4109"
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2970515
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$38.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.18
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$81.74
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$81.74
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
REACHER 26 6 OZ. #4109"
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2970515
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
REACHER 26 STANDARD #A665-17
|
Facility
|
OP
|
$274.00
|
|
| Hospital Charge Code |
2970862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
REACHER 26 STANDARD #A665-17
|
Facility
|
IP
|
$274.00
|
|
| Hospital Charge Code |
2970862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
READYWRAP QUICK-FIT FOOT #RQ-LE-AB-M23
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
2971698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$435.71 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$533.52
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
READYWRAP QUICK-FIT FOOT #RQ-LE-AB-M23
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
2971698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$248.98 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Aetna Managed Medicare |
$248.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.61
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: NAPHCARE Commercial |
$533.52
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$577.98
|
| Rate for Payer: Quartz Medicare Advantage |
$533.52
|
| Rate for Payer: The Alliance Commercial |
$444.60
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
REAMER 10.0MM CORING CR8850
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
2964943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.71 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Aetna Managed Medicare |
$750.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,500.40
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.84
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,742.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.67
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
REAMER 10.0MM CORING CR8850
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
2964943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,313.75 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,608.67
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
REAMER 10MM LOW PROFILE AR-1410LP
|
Facility
|
IP
|
$3,404.00
|
|
| Hospital Charge Code |
2964693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,734.68 |
| Max. Negotiated Rate |
$3,256.95 |
| Rate for Payer: Aetna Commercial |
$3,186.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,044.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,256.95
|
| Rate for Payer: Health EOS Commercial |
$3,150.74
|
| Rate for Payer: HFN Commercial |
$3,256.95
|
| Rate for Payer: Multiplan Commercial |
$2,832.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,256.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.68
|
| Rate for Payer: Quartz Commercial |
$2,124.10
|
| Rate for Payer: WEA Trust Commercial |
$1,947.09
|
| Rate for Payer: WPS Commercial |
$2,622.10
|
|
|
REAMER 10MM LOW PROFILE AR-1410LP
|
Facility
|
OP
|
$3,404.00
|
|
| Hospital Charge Code |
2964693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.24 |
| Max. Negotiated Rate |
$3,256.95 |
| Rate for Payer: Aetna Commercial |
$3,186.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,044.54
|
| Rate for Payer: Aetna Managed Medicare |
$991.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,301.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,770.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,699.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,256.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,981.13
|
| Rate for Payer: Health EOS Commercial |
$3,150.74
|
| Rate for Payer: HFN Commercial |
$3,256.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,655.12
|
| Rate for Payer: Multiplan Commercial |
$2,832.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,124.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,256.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.68
|
| Rate for Payer: Quartz Commercial |
$2,301.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,124.10
|
| Rate for Payer: The Alliance Commercial |
$1,770.08
|
| Rate for Payer: WEA Trust Commercial |
$1,947.09
|
| Rate for Payer: WPS Commercial |
$2,622.10
|
|
|
REAMER 11.OMM CORING CR8851
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
2964944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.71 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Aetna Managed Medicare |
$750.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,500.40
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.84
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,742.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.67
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
REAMER 11.OMM CORING CR8851
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
2964944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,313.75 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,608.67
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
REAMER 2.0 SMART TOE
|
Facility
|
IP
|
$3,149.00
|
|
| Hospital Charge Code |
2966088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,604.73 |
| Max. Negotiated Rate |
$3,012.96 |
| Rate for Payer: Aetna Commercial |
$2,947.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.73
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,012.96
|
| Rate for Payer: Health EOS Commercial |
$2,914.71
|
| Rate for Payer: HFN Commercial |
$3,012.96
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.73
|
| Rate for Payer: Quartz Commercial |
$1,964.98
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,425.67
|
|
|
REAMER 2.0 SMART TOE
|
Facility
|
OP
|
$3,149.00
|
|
| Hospital Charge Code |
2966088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.99 |
| Max. Negotiated Rate |
$3,012.96 |
| Rate for Payer: Aetna Commercial |
$2,947.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Aetna Managed Medicare |
$916.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,128.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,637.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,571.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.73
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,012.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,832.72
|
| Rate for Payer: Health EOS Commercial |
$2,914.71
|
| Rate for Payer: HFN Commercial |
$3,012.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,456.22
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,964.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.73
|
| Rate for Payer: Quartz Commercial |
$2,128.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,964.98
|
| Rate for Payer: The Alliance Commercial |
$1,637.48
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,425.67
|
|
|
REAMER 8.5MM PILOTED HEADED AR-1455
|
Facility
|
OP
|
$3,710.00
|
|
| Hospital Charge Code |
3661497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,080.35 |
| Max. Negotiated Rate |
$3,549.73 |
| Rate for Payer: Aetna Commercial |
$3,472.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,318.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,080.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,507.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,929.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,852.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.95
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$3,549.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,159.22
|
| Rate for Payer: Health EOS Commercial |
$3,433.98
|
| Rate for Payer: HFN Commercial |
$3,549.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.80
|
| Rate for Payer: Multiplan Commercial |
$3,086.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,315.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.62
|
| Rate for Payer: Quartz Commercial |
$2,507.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,315.04
|
| Rate for Payer: The Alliance Commercial |
$1,929.20
|
| Rate for Payer: WEA Trust Commercial |
$2,122.12
|
| Rate for Payer: WPS Commercial |
$2,857.81
|
|
|
REAMER 8.5MM PILOTED HEADED AR-1455
|
Facility
|
IP
|
$3,710.00
|
|
| Hospital Charge Code |
3661497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,890.62 |
| Max. Negotiated Rate |
$3,549.73 |
| Rate for Payer: Aetna Commercial |
$3,472.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,318.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.95
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$3,549.73
|
| Rate for Payer: Health EOS Commercial |
$3,433.98
|
| Rate for Payer: HFN Commercial |
$3,549.73
|
| Rate for Payer: Multiplan Commercial |
$3,086.72
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.62
|
| Rate for Payer: Quartz Commercial |
$2,315.04
|
| Rate for Payer: WEA Trust Commercial |
$2,122.12
|
| Rate for Payer: WPS Commercial |
$2,857.81
|
|
