|
RIMPLATE MATRIX ORBITAL 12HL 0.8MM THICK TI 04.503.397
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.62 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,534.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,562.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,740.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,630.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,067.14
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,110.60
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,288.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,562.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,288.48
|
| Rate for Payer: The Alliance Commercial |
$2,740.40
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
RING 3/4 EXTERNAL FIXATION
|
Facility
|
IP
|
$4,968.00
|
|
| Hospital Charge Code |
2966387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,531.69 |
| Max. Negotiated Rate |
$4,753.38 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,443.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,738.36
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,753.38
|
| Rate for Payer: Health EOS Commercial |
$4,598.38
|
| Rate for Payer: HFN Commercial |
$4,753.38
|
| Rate for Payer: Multiplan Commercial |
$4,133.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,753.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.69
|
| Rate for Payer: Quartz Commercial |
$3,100.03
|
| Rate for Payer: WEA Trust Commercial |
$2,841.70
|
| Rate for Payer: WPS Commercial |
$3,826.85
|
|
|
RING 3/4 EXTERNAL FIXATION
|
Facility
|
OP
|
$4,968.00
|
|
| Hospital Charge Code |
2966387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,446.68 |
| Max. Negotiated Rate |
$4,753.38 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,443.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,446.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,358.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,583.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,480.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,738.36
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,753.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,891.38
|
| Rate for Payer: Health EOS Commercial |
$4,598.38
|
| Rate for Payer: HFN Commercial |
$4,753.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,875.04
|
| Rate for Payer: Multiplan Commercial |
$4,133.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,100.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,753.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.69
|
| Rate for Payer: Quartz Commercial |
$3,358.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,100.03
|
| Rate for Payer: The Alliance Commercial |
$2,583.36
|
| Rate for Payer: WEA Trust Commercial |
$2,841.70
|
| Rate for Payer: WPS Commercial |
$3,826.85
|
|
|
RING BARRIER ADAPT FLAT #7806
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
2963736
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.82
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
RING BARRIER ADAPT FLAT #7806
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
2963736
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
RING CARBON FIBER F00T LONG 155MM HOFFMANN LIMB 4934-4-155
|
Facility
|
OP
|
$9,492.00
|
|
| Hospital Charge Code |
5685634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,764.07 |
| Max. Negotiated Rate |
$9,081.95 |
| Rate for Payer: Aetna Commercial |
$8,884.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,489.64
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,416.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,935.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,738.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,231.99
|
| Rate for Payer: Cash Price |
$2,847.60
|
| Rate for Payer: Cigna Commercial |
$9,081.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,524.34
|
| Rate for Payer: Health EOS Commercial |
$8,785.80
|
| Rate for Payer: HFN Commercial |
$9,081.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,403.76
|
| Rate for Payer: Multiplan Commercial |
$7,897.34
|
| Rate for Payer: NAPHCARE Commercial |
$5,923.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,081.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,837.12
|
| Rate for Payer: Quartz Commercial |
$6,416.59
|
| Rate for Payer: Quartz Medicare Advantage |
$5,923.01
|
| Rate for Payer: The Alliance Commercial |
$4,935.84
|
| Rate for Payer: WEA Trust Commercial |
$5,429.42
|
| Rate for Payer: WPS Commercial |
$7,311.69
|
|
|
RING CARBON FIBER F00T LONG 155MM HOFFMANN LIMB 4934-4-155
|
Facility
|
IP
|
$9,492.00
|
|
| Hospital Charge Code |
5685634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,837.12 |
| Max. Negotiated Rate |
$9,081.95 |
| Rate for Payer: Aetna Commercial |
$8,884.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,489.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,231.99
|
| Rate for Payer: Cash Price |
$2,847.60
|
| Rate for Payer: Cigna Commercial |
$9,081.95
|
| Rate for Payer: Health EOS Commercial |
$8,785.80
|
| Rate for Payer: HFN Commercial |
$9,081.95
|
| Rate for Payer: Multiplan Commercial |
$7,897.34
|
| Rate for Payer: Preferred Network Access Commercial |
$9,081.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,837.12
|
| Rate for Payer: Quartz Commercial |
$5,923.01
|
| Rate for Payer: WEA Trust Commercial |
$5,429.42
|
| Rate for Payer: WPS Commercial |
$7,311.69
|
|
|
RING CARBON FIBER FULL 155MM HOFFMANN LIMB 4933-5-155
|
Facility
|
OP
|
$7,093.00
|
|
| Hospital Charge Code |
5685629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,065.48 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,065.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,794.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,688.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,540.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.13
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,532.54
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,794.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,426.03
|
| Rate for Payer: The Alliance Commercial |
$3,688.36
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
RING CARBON FIBER FULL 155MM HOFFMANN LIMB 4933-5-155
|
Facility
|
IP
|
$7,093.00
|
|
| Hospital Charge Code |
5685629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,614.59 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,426.03
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
RING CARBON FIBER FULL 210MM HOFFMANN LIMB 4933-5-210
|
Facility
|
OP
|
$7,093.00
|
|
| Hospital Charge Code |
5599708
|
| Min. Negotiated Rate |
$2,065.48 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,065.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,794.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,688.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,540.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.13
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,532.54
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,794.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,426.03
|
| Rate for Payer: The Alliance Commercial |
$3,688.36
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
RING CARBON FIBER FULL 210MM HOFFMANN LIMB 4933-5-210
|
Facility
|
IP
|
$7,093.00
|
|
| Hospital Charge Code |
5599708
|
| Min. Negotiated Rate |
$3,614.59 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,426.03
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
RING MALYUGIN 6.25 MAL-1001-1
|
Facility
|
OP
|
$2,131.00
|
|
| Hospital Charge Code |
2969501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.55 |
| Max. Negotiated Rate |
$2,038.94 |
| Rate for Payer: Aetna Commercial |
$1,994.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Aetna Managed Medicare |
$620.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,440.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.61
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,038.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.24
|
| Rate for Payer: Health EOS Commercial |
$1,972.45
|
| Rate for Payer: HFN Commercial |
$2,038.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.18
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.96
|
| Rate for Payer: Quartz Commercial |
$1,440.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.74
|
| Rate for Payer: The Alliance Commercial |
$1,108.12
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,641.51
|
|
|
RING MALYUGIN 6.25 MAL-1001-1
|
Facility
|
IP
|
$2,131.00
|
|
| Hospital Charge Code |
2969501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,085.96 |
| Max. Negotiated Rate |
$2,038.94 |
| Rate for Payer: Aetna Commercial |
$1,994.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.61
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,038.94
|
| Rate for Payer: Health EOS Commercial |
$1,972.45
|
| Rate for Payer: HFN Commercial |
$2,038.94
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.96
|
| Rate for Payer: Quartz Commercial |
$1,329.74
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,641.51
|
|
|
RING MALYUGIN 7.0 MAL-0002
|
Facility
|
IP
|
$1,857.00
|
|
| Hospital Charge Code |
5415296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$946.33 |
| Max. Negotiated Rate |
$1,776.78 |
| Rate for Payer: Aetna Commercial |
$1,738.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,660.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.58
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna Commercial |
$1,776.78
|
| Rate for Payer: Health EOS Commercial |
$1,718.84
|
| Rate for Payer: HFN Commercial |
$1,776.78
|
| Rate for Payer: Multiplan Commercial |
$1,545.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,776.78
|
| Rate for Payer: Quartz Beloit One Network |
$946.33
|
| Rate for Payer: Quartz Commercial |
$1,158.77
|
| Rate for Payer: WEA Trust Commercial |
$1,062.20
|
| Rate for Payer: WPS Commercial |
$1,430.45
|
|
|
RING MALYUGIN 7.0 MAL-0002
|
Facility
|
OP
|
$1,857.00
|
|
| Hospital Charge Code |
5415296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.76 |
| Max. Negotiated Rate |
$1,776.78 |
| Rate for Payer: Aetna Commercial |
$1,738.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,660.90
|
| Rate for Payer: Aetna Managed Medicare |
$540.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,255.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$965.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$927.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.58
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna Commercial |
$1,776.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,080.77
|
| Rate for Payer: Health EOS Commercial |
$1,718.84
|
| Rate for Payer: HFN Commercial |
$1,776.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,448.46
|
| Rate for Payer: Multiplan Commercial |
$1,545.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,158.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,776.78
|
| Rate for Payer: Quartz Beloit One Network |
$946.33
|
| Rate for Payer: Quartz Commercial |
$1,255.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,158.77
|
| Rate for Payer: The Alliance Commercial |
$965.64
|
| Rate for Payer: WEA Trust Commercial |
$1,062.20
|
| Rate for Payer: WPS Commercial |
$1,430.45
|
|
|
RING OSTOMY ADAPT BARRIER 79520
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
2969230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
RING OSTOMY ADAPT BARRIER 79520
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
2969230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
RING REFORM CAPSULAR TENSION 11MM ACTR11 8065225704
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
CPT 66982
|
| Hospital Charge Code |
4519976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.90 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Anthem Medicare Advantage |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
RING REFORM CAPSULAR TENSION 11MM ACTR11 8065225704
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
CPT 66982
|
| Hospital Charge Code |
4519976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.75 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,251.12
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
RING RETRACTOR ALEXIS S/M (ORTHO) HR104
|
Facility
|
OP
|
$2,270.00
|
|
| Hospital Charge Code |
6226124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.02 |
| Max. Negotiated Rate |
$2,171.94 |
| Rate for Payer: Aetna Commercial |
$2,124.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.29
|
| Rate for Payer: Aetna Managed Medicare |
$661.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,534.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,180.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,133.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.22
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,171.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,321.14
|
| Rate for Payer: Health EOS Commercial |
$2,101.11
|
| Rate for Payer: HFN Commercial |
$2,171.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,770.60
|
| Rate for Payer: Multiplan Commercial |
$1,888.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,416.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.79
|
| Rate for Payer: Quartz Commercial |
$1,534.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,416.48
|
| Rate for Payer: The Alliance Commercial |
$1,180.40
|
| Rate for Payer: WEA Trust Commercial |
$1,298.44
|
| Rate for Payer: WPS Commercial |
$1,748.58
|
|
|
RING RETRACTOR ALEXIS S/M (ORTHO) HR104
|
Facility
|
IP
|
$2,270.00
|
|
| Hospital Charge Code |
6226124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.79 |
| Max. Negotiated Rate |
$2,171.94 |
| Rate for Payer: Aetna Commercial |
$2,124.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.22
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,171.94
|
| Rate for Payer: Health EOS Commercial |
$2,101.11
|
| Rate for Payer: HFN Commercial |
$2,171.94
|
| Rate for Payer: Multiplan Commercial |
$1,888.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.79
|
| Rate for Payer: Quartz Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,298.44
|
| Rate for Payer: WPS Commercial |
$1,748.58
|
|
|
RING SKIN BARRIER 2 7805
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2969206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
RING SKIN BARRIER 2 7805
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2969206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
Risperidone
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$232.18 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$232.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$222.40
|
| Rate for Payer: HFN Commercial |
$232.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$232.18
|
| Rate for Payer: Quartz Beloit One Network |
$107.54
|
| Rate for Payer: Quartz Commercial |
$139.31
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Risperidone
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
