|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED MEDIUM AR-9275-M
|
Facility
|
IP
|
$3,018.00
|
|
| Hospital Charge Code |
5895635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$2,887.62 |
| Rate for Payer: Aetna Commercial |
$2,824.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.52
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,887.62
|
| Rate for Payer: Health EOS Commercial |
$2,793.46
|
| Rate for Payer: HFN Commercial |
$2,887.62
|
| Rate for Payer: Multiplan Commercial |
$2,510.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.97
|
| Rate for Payer: Quartz Commercial |
$1,883.23
|
| Rate for Payer: WEA Trust Commercial |
$1,726.30
|
| Rate for Payer: WPS Commercial |
$2,324.77
|
|
|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED SMALL AR-9275-S
|
Facility
|
IP
|
$2,790.00
|
|
| Hospital Charge Code |
6178082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.78 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,740.96
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED SMALL AR-9275-S
|
Facility
|
OP
|
$2,790.00
|
|
| Hospital Charge Code |
6178082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Aetna Managed Medicare |
$812.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.78
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,886.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.96
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
REAMER VIP GLENOID AUGMENTED MGS SMALL AR-5410-AMGS-S
|
Facility
|
OP
|
$4,256.00
|
|
| Hospital Charge Code |
6204973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,239.35 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,877.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.99
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,319.68
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,877.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.74
|
| Rate for Payer: The Alliance Commercial |
$2,213.12
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
REAMER VIP GLENOID AUGMENTED MGS SMALL AR-5410-AMGS-S
|
Facility
|
IP
|
$4,256.00
|
|
| Hospital Charge Code |
6204973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,168.86 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,655.74
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
REAMING ROD W BALL TIP 2.5MM 650MM 351.709S
|
Facility
|
IP
|
$1,880.00
|
|
| Hospital Charge Code |
2966384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$958.05 |
| Max. Negotiated Rate |
$1,798.78 |
| Rate for Payer: Aetna Commercial |
$1,759.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.26
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$1,798.78
|
| Rate for Payer: Health EOS Commercial |
$1,740.13
|
| Rate for Payer: HFN Commercial |
$1,798.78
|
| Rate for Payer: Multiplan Commercial |
$1,564.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.78
|
| Rate for Payer: Quartz Beloit One Network |
$958.05
|
| Rate for Payer: Quartz Commercial |
$1,173.12
|
| Rate for Payer: WEA Trust Commercial |
$1,075.36
|
| Rate for Payer: WPS Commercial |
$1,448.16
|
|
|
REAMING ROD W BALL TIP 2.5MM 650MM 351.709S
|
Facility
|
OP
|
$1,880.00
|
|
| Hospital Charge Code |
2966384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.46 |
| Max. Negotiated Rate |
$1,798.78 |
| Rate for Payer: Aetna Commercial |
$1,759.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.47
|
| Rate for Payer: Aetna Managed Medicare |
$547.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,270.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$977.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$938.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.26
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$1,798.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.16
|
| Rate for Payer: Health EOS Commercial |
$1,740.13
|
| Rate for Payer: HFN Commercial |
$1,798.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.40
|
| Rate for Payer: Multiplan Commercial |
$1,564.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.78
|
| Rate for Payer: Quartz Beloit One Network |
$958.05
|
| Rate for Payer: Quartz Commercial |
$1,270.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,173.12
|
| Rate for Payer: The Alliance Commercial |
$977.60
|
| Rate for Payer: WEA Trust Commercial |
$1,075.36
|
| Rate for Payer: WPS Commercial |
$1,448.16
|
|
|
Reclast 5 mg Charge
|
Facility
|
OP
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$5,708.27 |
| Rate for Payer: Aetna Commercial |
$5,584.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,033.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,102.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,978.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,288.46
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,708.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.54
|
| Rate for Payer: Health EOS Commercial |
$5,522.13
|
| Rate for Payer: HFN Commercial |
$5,708.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,653.48
|
| Rate for Payer: Multiplan Commercial |
$4,963.71
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,708.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,040.27
|
| Rate for Payer: Quartz Commercial |
$4,033.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.78
|
| Rate for Payer: The Alliance Commercial |
$21.13
|
| Rate for Payer: WEA Trust Commercial |
$3,412.55
|
| Rate for Payer: WPS Commercial |
$18.03
|
|
|
Reclast 5 mg Charge
|
Professional
|
Both
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$5,894.41 |
| Rate for Payer: Aetna Commercial |
$5,894.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,894.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.21
|
| Rate for Payer: Health EOS Commercial |
$5,646.22
|
| Rate for Payer: HFN Commercial |
$5,894.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$4,963.71
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,730.04
|
| Rate for Payer: Quartz Commercial |
$3,536.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$14.53
|
| Rate for Payer: United Healthcare Medicaid |
$5.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$3,412.55
|
| Rate for Payer: WPS Commercial |
$18.03
|
|
|
Reclast 5 mg Charge
|
Facility
|
IP
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,040.27 |
| Max. Negotiated Rate |
$5,708.27 |
| Rate for Payer: Aetna Commercial |
$5,584.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,288.46
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,708.27
|
| Rate for Payer: Health EOS Commercial |
$5,522.13
|
| Rate for Payer: HFN Commercial |
$5,708.27
|
| Rate for Payer: Multiplan Commercial |
$4,963.71
|
| Rate for Payer: Preferred Network Access Commercial |
$5,708.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,040.27
|
| Rate for Payer: Quartz Commercial |
$3,722.78
|
| Rate for Payer: WEA Trust Commercial |
$3,412.55
|
| Rate for Payer: WPS Commercial |
$4,595.61
|
|
|
Reclast 5mg charge J3489
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,112.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,163.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.54
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,744.74
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,795.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$4,112.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,795.79
|
| Rate for Payer: The Alliance Commercial |
$21.13
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$18.03
|
|
|
Reclast 5mg charge J3489
|
Professional
|
Both
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$6,010.00 |
| Rate for Payer: Aetna Commercial |
$6,010.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$6,010.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.21
|
| Rate for Payer: Health EOS Commercial |
$5,756.95
|
| Rate for Payer: HFN Commercial |
$6,010.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$6,010.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.58
|
| Rate for Payer: Quartz Commercial |
$3,606.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$14.53
|
| Rate for Payer: United Healthcare Medicaid |
$5.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$18.03
|
|
|
Reclast 5mg charge J3489
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,099.90 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$3,795.79
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
|
RECON SCREW 6.5MM/100MM X L40MM FOR IM NAIL 04.046.700S
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.27 |
| Max. Negotiated Rate |
$2,219.78 |
| Rate for Payer: Aetna Commercial |
$2,171.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.78
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,219.78
|
| Rate for Payer: Health EOS Commercial |
$2,147.39
|
| Rate for Payer: HFN Commercial |
$2,219.78
|
| Rate for Payer: Multiplan Commercial |
$1,930.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.27
|
| Rate for Payer: Quartz Commercial |
$1,447.68
|
| Rate for Payer: WEA Trust Commercial |
$1,327.04
|
| Rate for Payer: WPS Commercial |
$1,787.10
|
|
|
RECON SCREW 6.5MM/100MM X L40MM FOR IM NAIL 04.046.700S
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.58 |
| Max. Negotiated Rate |
$2,219.78 |
| Rate for Payer: Aetna Commercial |
$2,171.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.01
|
| Rate for Payer: Aetna Managed Medicare |
$675.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,568.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,158.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.78
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,219.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.24
|
| Rate for Payer: Health EOS Commercial |
$2,147.39
|
| Rate for Payer: HFN Commercial |
$2,219.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,809.60
|
| Rate for Payer: Multiplan Commercial |
$1,930.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.27
|
| Rate for Payer: Quartz Commercial |
$1,568.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,447.68
|
| Rate for Payer: The Alliance Commercial |
$1,206.40
|
| Rate for Payer: WEA Trust Commercial |
$1,327.04
|
| Rate for Payer: WPS Commercial |
$1,787.10
|
|
|
RECON SCREW 6.5MM/105MM X L40MM FOR IM NAIL 04.046.705S
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.58 |
| Max. Negotiated Rate |
$2,219.78 |
| Rate for Payer: Aetna Commercial |
$2,171.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.01
|
| Rate for Payer: Aetna Managed Medicare |
$675.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,568.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,158.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.78
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,219.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.24
|
| Rate for Payer: Health EOS Commercial |
$2,147.39
|
| Rate for Payer: HFN Commercial |
$2,219.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,809.60
|
| Rate for Payer: Multiplan Commercial |
$1,930.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.27
|
| Rate for Payer: Quartz Commercial |
$1,568.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,447.68
|
| Rate for Payer: The Alliance Commercial |
$1,206.40
|
| Rate for Payer: WEA Trust Commercial |
$1,327.04
|
| Rate for Payer: WPS Commercial |
$1,787.10
|
|
|
RECON SCREW 6.5MM/105MM X L40MM FOR IM NAIL 04.046.705S
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.27 |
| Max. Negotiated Rate |
$2,219.78 |
| Rate for Payer: Aetna Commercial |
$2,171.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.78
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,219.78
|
| Rate for Payer: Health EOS Commercial |
$2,147.39
|
| Rate for Payer: HFN Commercial |
$2,219.78
|
| Rate for Payer: Multiplan Commercial |
$1,930.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.27
|
| Rate for Payer: Quartz Commercial |
$1,447.68
|
| Rate for Payer: WEA Trust Commercial |
$1,327.04
|
| Rate for Payer: WPS Commercial |
$1,787.10
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 23420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,105.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
RECTAL EXAM/PROLAPSE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
RECTAL EXAM/PROLAPSE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$57,830.24
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$18,443.82 |
| Max. Negotiated Rate |
$57,830.24 |
| Rate for Payer: Aetna Managed Medicare |
$18,443.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51,104.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39,171.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37,215.50
|
| Rate for Payer: Anthem Medicare Advantage |
$18,443.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,443.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,443.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,443.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,312.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,443.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,172.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,443.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,443.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,443.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,443.82
|
| Rate for Payer: NAPHCARE Commercial |
$27,665.73
|
| Rate for Payer: Quartz Medicare Advantage |
$18,443.82
|
| Rate for Payer: The Alliance Commercial |
$57,830.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,443.82
|
| Rate for Payer: United Healthcare PPO |
$32,831.65
|
| Rate for Payer: Wellcare Medicare |
$18,443.82
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$101,371.92
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$28,234.81 |
| Max. Negotiated Rate |
$101,371.92 |
| Rate for Payer: Aetna Managed Medicare |
$28,234.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79,000.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,553.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,529.74
|
| Rate for Payer: Anthem Medicare Advantage |
$28,234.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,234.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,234.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,234.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,863.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,234.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,567.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,234.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,234.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,234.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,234.81
|
| Rate for Payer: NAPHCARE Commercial |
$42,352.22
|
| Rate for Payer: Quartz Medicare Advantage |
$28,234.81
|
| Rate for Payer: The Alliance Commercial |
$101,371.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,234.81
|
| Rate for Payer: United Healthcare PPO |
$57,273.42
|
| Rate for Payer: Wellcare Medicare |
$28,234.81
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$44,713.76
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$13,050.14 |
| Max. Negotiated Rate |
$44,713.76 |
| Rate for Payer: Aetna Managed Medicare |
$13,050.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,737.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,392.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,024.79
|
| Rate for Payer: Anthem Medicare Advantage |
$13,050.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,050.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,050.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,050.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,889.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,050.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,551.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,050.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,050.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,050.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,050.14
|
| Rate for Payer: NAPHCARE Commercial |
$19,575.21
|
| Rate for Payer: Quartz Medicare Advantage |
$13,050.14
|
| Rate for Payer: The Alliance Commercial |
$44,713.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,050.14
|
| Rate for Payer: United Healthcare PPO |
$25,341.70
|
| Rate for Payer: Wellcare Medicare |
$13,050.14
|
|
|
Rectal Sensation, Tone And Compliance Test
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
1190817
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$1,897.97 |
| Rate for Payer: Aetna Commercial |
$484.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$484.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.76
|
| Rate for Payer: Health EOS Commercial |
$463.74
|
| Rate for Payer: HFN Commercial |
$484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,897.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,897.97
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$484.12
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$290.47
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
