SLING ARM BLUE INFNT 10101
|
Facility
|
IP
|
$102.00
|
|
Hospital Charge Code |
2974213
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$49.98 |
Max. Negotiated Rate |
$93.84 |
Rate for Payer: Aetna Commercial |
$91.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
Rate for Payer: Cash Price |
$30.60
|
Rate for Payer: Cigna Commercial |
$93.84
|
Rate for Payer: Health EOS Commercial |
$90.78
|
Rate for Payer: HFN Commercial |
$93.84
|
Rate for Payer: Multiplan Commercial |
$81.60
|
Rate for Payer: NAPHCARE Commercial |
$61.20
|
Rate for Payer: Preferred Network Access Commercial |
$93.84
|
Rate for Payer: Quartz Beloit One Network |
$49.98
|
Rate for Payer: Quartz Commercial |
$61.20
|
Rate for Payer: WEA Trust Commercial |
$56.10
|
Rate for Payer: WPS Commercial |
$75.55
|
|
SLING ARM CHILD 8001-01
|
Facility
|
IP
|
$110.00
|
|
Hospital Charge Code |
2974227
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$53.90 |
Max. Negotiated Rate |
$101.20 |
Rate for Payer: Aetna Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cigna Commercial |
$101.20
|
Rate for Payer: Health EOS Commercial |
$97.90
|
Rate for Payer: HFN Commercial |
$101.20
|
Rate for Payer: Multiplan Commercial |
$88.00
|
Rate for Payer: NAPHCARE Commercial |
$66.00
|
Rate for Payer: Preferred Network Access Commercial |
$101.20
|
Rate for Payer: Quartz Beloit One Network |
$53.90
|
Rate for Payer: Quartz Commercial |
$66.00
|
Rate for Payer: WEA Trust Commercial |
$60.50
|
Rate for Payer: WPS Commercial |
$81.48
|
|
SLING ARM CHILD 8001-01
|
Facility
|
OP
|
$110.00
|
|
Hospital Charge Code |
2974227
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$30.80 |
Max. Negotiated Rate |
$440.00 |
Rate for Payer: Aetna Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
Rate for Payer: Aetna Managed Medicare |
$30.80
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cigna Commercial |
$101.20
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
Rate for Payer: Health EOS Commercial |
$97.90
|
Rate for Payer: HFN Commercial |
$101.20
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.50
|
Rate for Payer: Multiplan Commercial |
$88.00
|
Rate for Payer: NAPHCARE Commercial |
$66.00
|
Rate for Payer: Preferred Network Access Commercial |
$101.20
|
Rate for Payer: Quartz Beloit One Network |
$53.90
|
Rate for Payer: Quartz Commercial |
$71.50
|
Rate for Payer: Quartz Medicare Advantage |
$66.00
|
Rate for Payer: The Alliance Commercial |
$440.00
|
Rate for Payer: WEA Trust Commercial |
$60.50
|
Rate for Payer: WPS Commercial |
$81.48
|
|
SLING ARM CHILD/S NAVY V9902-03
|
Facility
|
IP
|
$120.00
|
|
Hospital Charge Code |
2964034
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$58.80 |
Max. Negotiated Rate |
$110.40 |
Rate for Payer: Aetna Commercial |
$108.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
Rate for Payer: Cash Price |
$36.00
|
Rate for Payer: Cigna Commercial |
$110.40
|
Rate for Payer: Health EOS Commercial |
$106.80
|
Rate for Payer: HFN Commercial |
$110.40
|
Rate for Payer: Multiplan Commercial |
$96.00
|
Rate for Payer: NAPHCARE Commercial |
$72.00
|
Rate for Payer: Preferred Network Access Commercial |
$110.40
|
Rate for Payer: Quartz Beloit One Network |
$58.80
|
Rate for Payer: Quartz Commercial |
$72.00
|
Rate for Payer: WEA Trust Commercial |
$66.00
|
Rate for Payer: WPS Commercial |
$88.88
|
|
SLING ARM CHILD/S NAVY V9902-03
|
Facility
|
OP
|
$120.00
|
|
Hospital Charge Code |
2964034
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$33.60 |
Max. Negotiated Rate |
$480.00 |
Rate for Payer: Aetna Commercial |
$108.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
Rate for Payer: Aetna Managed Medicare |
$33.60
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
Rate for Payer: Cash Price |
$36.00
|
Rate for Payer: Cigna Commercial |
$110.40
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
Rate for Payer: Health EOS Commercial |
$106.80
|
Rate for Payer: HFN Commercial |
$110.40
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
Rate for Payer: Multiplan Commercial |
$96.00
|
Rate for Payer: NAPHCARE Commercial |
$72.00
|
Rate for Payer: Preferred Network Access Commercial |
$110.40
|
Rate for Payer: Quartz Beloit One Network |
$58.80
|
Rate for Payer: Quartz Commercial |
$78.00
|
Rate for Payer: Quartz Medicare Advantage |
$72.00
|
Rate for Payer: The Alliance Commercial |
$480.00
|
Rate for Payer: WEA Trust Commercial |
$66.00
|
Rate for Payer: WPS Commercial |
$88.88
|
|
SLING ARM CHILD TX9902-02
|
Facility
|
IP
|
$110.00
|
|
Hospital Charge Code |
3072427
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$53.90 |
Max. Negotiated Rate |
$101.20 |
Rate for Payer: Aetna Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cigna Commercial |
$101.20
|
Rate for Payer: Health EOS Commercial |
$97.90
|
Rate for Payer: HFN Commercial |
$101.20
|
Rate for Payer: Multiplan Commercial |
$88.00
|
Rate for Payer: NAPHCARE Commercial |
$66.00
|
Rate for Payer: Preferred Network Access Commercial |
$101.20
|
Rate for Payer: Quartz Beloit One Network |
$53.90
|
Rate for Payer: Quartz Commercial |
$66.00
|
Rate for Payer: WEA Trust Commercial |
$60.50
|
Rate for Payer: WPS Commercial |
$81.48
|
|
SLING ARM CHILD TX9902-02
|
Facility
|
OP
|
$110.00
|
|
Hospital Charge Code |
3072427
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$30.80 |
Max. Negotiated Rate |
$440.00 |
Rate for Payer: Aetna Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
Rate for Payer: Aetna Managed Medicare |
$30.80
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cigna Commercial |
$101.20
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
Rate for Payer: Health EOS Commercial |
$97.90
|
Rate for Payer: HFN Commercial |
$101.20
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.50
|
Rate for Payer: Multiplan Commercial |
$88.00
|
Rate for Payer: NAPHCARE Commercial |
$66.00
|
Rate for Payer: Preferred Network Access Commercial |
$101.20
|
Rate for Payer: Quartz Beloit One Network |
$53.90
|
Rate for Payer: Quartz Commercial |
$71.50
|
Rate for Payer: Quartz Medicare Advantage |
$66.00
|
Rate for Payer: The Alliance Commercial |
$440.00
|
Rate for Payer: WEA Trust Commercial |
$60.50
|
Rate for Payer: WPS Commercial |
$81.48
|
|
SLING ARM SM 8001-02
|
Facility
|
IP
|
$112.00
|
|
Hospital Charge Code |
2974242
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$54.88 |
Max. Negotiated Rate |
$103.04 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$67.20
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ARM SM 8001-02
|
Facility
|
OP
|
$112.00
|
|
Hospital Charge Code |
2974242
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$31.36 |
Max. Negotiated Rate |
$448.00 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Aetna Managed Medicare |
$31.36
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$72.80
|
Rate for Payer: Quartz Medicare Advantage |
$67.20
|
Rate for Payer: The Alliance Commercial |
$448.00
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ARM STRAP MEDIUM W/ PAD 8006-03
|
Facility
|
OP
|
$162.00
|
|
Hospital Charge Code |
2964024
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$45.36 |
Max. Negotiated Rate |
$648.00 |
Rate for Payer: Aetna Commercial |
$145.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
Rate for Payer: Aetna Managed Medicare |
$45.36
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.30
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
Rate for Payer: Cash Price |
$48.60
|
Rate for Payer: Cigna Commercial |
$149.04
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$90.66
|
Rate for Payer: Health EOS Commercial |
$144.18
|
Rate for Payer: HFN Commercial |
$149.04
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.50
|
Rate for Payer: Multiplan Commercial |
$129.60
|
Rate for Payer: NAPHCARE Commercial |
$97.20
|
Rate for Payer: Preferred Network Access Commercial |
$149.04
|
Rate for Payer: Quartz Beloit One Network |
$79.38
|
Rate for Payer: Quartz Commercial |
$105.30
|
Rate for Payer: Quartz Medicare Advantage |
$97.20
|
Rate for Payer: The Alliance Commercial |
$648.00
|
Rate for Payer: WEA Trust Commercial |
$89.10
|
Rate for Payer: WPS Commercial |
$119.99
|
|
SLING ARM STRAP MEDIUM W/ PAD 8006-03
|
Facility
|
IP
|
$162.00
|
|
Hospital Charge Code |
2964024
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$79.38 |
Max. Negotiated Rate |
$149.04 |
Rate for Payer: Aetna Commercial |
$145.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
Rate for Payer: Cash Price |
$48.60
|
Rate for Payer: Cigna Commercial |
$149.04
|
Rate for Payer: Health EOS Commercial |
$144.18
|
Rate for Payer: HFN Commercial |
$149.04
|
Rate for Payer: Multiplan Commercial |
$129.60
|
Rate for Payer: NAPHCARE Commercial |
$97.20
|
Rate for Payer: Preferred Network Access Commercial |
$149.04
|
Rate for Payer: Quartz Beloit One Network |
$79.38
|
Rate for Payer: Quartz Commercial |
$97.20
|
Rate for Payer: WEA Trust Commercial |
$89.10
|
Rate for Payer: WPS Commercial |
$119.99
|
|
SLING ARM XL 8001-05
|
Facility
|
IP
|
$112.00
|
|
Hospital Charge Code |
2974240
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$54.88 |
Max. Negotiated Rate |
$103.04 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$67.20
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ARM XL 8001-05
|
Facility
|
OP
|
$112.00
|
|
Hospital Charge Code |
2974240
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$31.36 |
Max. Negotiated Rate |
$448.00 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Aetna Managed Medicare |
$31.36
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$72.80
|
Rate for Payer: Quartz Medicare Advantage |
$67.20
|
Rate for Payer: The Alliance Commercial |
$448.00
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ENVELOPE ARM LG 8001-04
|
Facility
|
OP
|
$112.00
|
|
Hospital Charge Code |
2974239
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$31.36 |
Max. Negotiated Rate |
$448.00 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Aetna Managed Medicare |
$31.36
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$72.80
|
Rate for Payer: Quartz Medicare Advantage |
$67.20
|
Rate for Payer: The Alliance Commercial |
$448.00
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ENVELOPE ARM LG 8001-04
|
Facility
|
IP
|
$112.00
|
|
Hospital Charge Code |
2974239
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$54.88 |
Max. Negotiated Rate |
$103.04 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$67.20
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ENVELOPE ARM MED 8001-03
|
Facility
|
IP
|
$112.00
|
|
Hospital Charge Code |
2974241
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$54.88 |
Max. Negotiated Rate |
$103.04 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$67.20
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING ENVELOPE ARM MED 8001-03
|
Facility
|
OP
|
$112.00
|
|
Hospital Charge Code |
2974241
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$31.36 |
Max. Negotiated Rate |
$448.00 |
Rate for Payer: Aetna Commercial |
$100.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
Rate for Payer: Aetna Managed Medicare |
$31.36
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
Rate for Payer: Cash Price |
$33.60
|
Rate for Payer: Cigna Commercial |
$103.04
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
Rate for Payer: Health EOS Commercial |
$99.68
|
Rate for Payer: HFN Commercial |
$103.04
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
Rate for Payer: Multiplan Commercial |
$89.60
|
Rate for Payer: NAPHCARE Commercial |
$67.20
|
Rate for Payer: Preferred Network Access Commercial |
$103.04
|
Rate for Payer: Quartz Beloit One Network |
$54.88
|
Rate for Payer: Quartz Commercial |
$72.80
|
Rate for Payer: Quartz Medicare Advantage |
$67.20
|
Rate for Payer: The Alliance Commercial |
$448.00
|
Rate for Payer: WEA Trust Commercial |
$61.60
|
Rate for Payer: WPS Commercial |
$82.96
|
|
SLING LARGE 190-320LB #50312
|
Facility
|
OP
|
$2,550.00
|
|
Hospital Charge Code |
2970185
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$714.00 |
Max. Negotiated Rate |
$10,200.00 |
Rate for Payer: Aetna Commercial |
$2,295.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,193.00
|
Rate for Payer: Aetna Managed Medicare |
$714.00
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,657.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,275.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,224.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,351.50
|
Rate for Payer: Cash Price |
$765.00
|
Rate for Payer: Cigna Commercial |
$2,346.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$1,426.98
|
Rate for Payer: Health EOS Commercial |
$2,269.50
|
Rate for Payer: HFN Commercial |
$2,346.00
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,912.50
|
Rate for Payer: Multiplan Commercial |
$2,040.00
|
Rate for Payer: NAPHCARE Commercial |
$1,530.00
|
Rate for Payer: Preferred Network Access Commercial |
$2,346.00
|
Rate for Payer: Quartz Beloit One Network |
$1,249.50
|
Rate for Payer: Quartz Commercial |
$1,657.50
|
Rate for Payer: Quartz Medicare Advantage |
$1,530.00
|
Rate for Payer: The Alliance Commercial |
$10,200.00
|
Rate for Payer: WEA Trust Commercial |
$1,402.50
|
Rate for Payer: WPS Commercial |
$1,888.78
|
|
SLING LARGE 190-320LB #50312
|
Facility
|
IP
|
$2,550.00
|
|
Hospital Charge Code |
2970185
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$1,249.50 |
Max. Negotiated Rate |
$2,346.00 |
Rate for Payer: Aetna Commercial |
$2,295.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,193.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,351.50
|
Rate for Payer: Cash Price |
$765.00
|
Rate for Payer: Cigna Commercial |
$2,346.00
|
Rate for Payer: Health EOS Commercial |
$2,269.50
|
Rate for Payer: HFN Commercial |
$2,346.00
|
Rate for Payer: Multiplan Commercial |
$2,040.00
|
Rate for Payer: NAPHCARE Commercial |
$1,530.00
|
Rate for Payer: Preferred Network Access Commercial |
$2,346.00
|
Rate for Payer: Quartz Beloit One Network |
$1,249.50
|
Rate for Payer: Quartz Commercial |
$1,530.00
|
Rate for Payer: WEA Trust Commercial |
$1,402.50
|
Rate for Payer: WPS Commercial |
$1,888.78
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$19,665.00
|
|
Service Code
|
CPT 57288
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$4,240.00 |
Max. Negotiated Rate |
$19,665.00 |
Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
Rate for Payer: The Alliance Commercial |
$19,665.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
Rate for Payer: United Healthcare PPO |
$4,240.00
|
Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
Slings A4565
|
Professional
|
Both
|
$28.00
|
|
Service Code
|
HCPCS A4565
|
Hospital Charge Code |
3133607
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$12.32 |
Max. Negotiated Rate |
$31.84 |
Rate for Payer: Aetna Commercial |
$26.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cigna Commercial |
$26.60
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
Rate for Payer: Health EOS Commercial |
$25.48
|
Rate for Payer: HFN Commercial |
$26.60
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.84
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.84
|
Rate for Payer: Multiplan Commercial |
$22.40
|
Rate for Payer: Preferred Network Access Commercial |
$26.60
|
Rate for Payer: Quartz Beloit One Network |
$12.32
|
Rate for Payer: Quartz Commercial |
$15.96
|
Rate for Payer: The Alliance Commercial |
$14.00
|
Rate for Payer: WEA Trust Commercial |
$15.40
|
Rate for Payer: WPS Commercial |
$20.74
|
|
Slings A4565
|
Facility
|
OP
|
$28.00
|
|
Service Code
|
HCPCS A4565
|
Hospital Charge Code |
3133607
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.84 |
Max. Negotiated Rate |
$112.00 |
Rate for Payer: Aetna Commercial |
$25.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
Rate for Payer: Aetna Managed Medicare |
$7.84
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.20
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.44
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cigna Commercial |
$25.76
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
Rate for Payer: Health EOS Commercial |
$24.92
|
Rate for Payer: HFN Commercial |
$25.76
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.00
|
Rate for Payer: Multiplan Commercial |
$22.40
|
Rate for Payer: NAPHCARE Commercial |
$16.80
|
Rate for Payer: Preferred Network Access Commercial |
$25.76
|
Rate for Payer: Quartz Beloit One Network |
$13.72
|
Rate for Payer: Quartz Commercial |
$18.20
|
Rate for Payer: Quartz Medicare Advantage |
$16.80
|
Rate for Payer: The Alliance Commercial |
$112.00
|
Rate for Payer: WEA Trust Commercial |
$15.40
|
Rate for Payer: WPS Commercial |
$20.74
|
|
Slings A4565
|
Facility
|
IP
|
$28.00
|
|
Service Code
|
HCPCS A4565
|
Hospital Charge Code |
3133607
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$13.72 |
Max. Negotiated Rate |
$25.76 |
Rate for Payer: Aetna Commercial |
$25.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cigna Commercial |
$25.76
|
Rate for Payer: Health EOS Commercial |
$24.92
|
Rate for Payer: HFN Commercial |
$25.76
|
Rate for Payer: Multiplan Commercial |
$22.40
|
Rate for Payer: NAPHCARE Commercial |
$16.80
|
Rate for Payer: Preferred Network Access Commercial |
$25.76
|
Rate for Payer: Quartz Beloit One Network |
$13.72
|
Rate for Payer: Quartz Commercial |
$16.80
|
Rate for Payer: WEA Trust Commercial |
$15.40
|
Rate for Payer: WPS Commercial |
$20.74
|
|
SLING STRAP ARM LARGE W/ PAD 8006-04
|
Facility
|
IP
|
$74.00
|
|
Hospital Charge Code |
2964021
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$36.26 |
Max. Negotiated Rate |
$68.08 |
Rate for Payer: Aetna Commercial |
$66.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
Rate for Payer: Cash Price |
$22.20
|
Rate for Payer: Cigna Commercial |
$68.08
|
Rate for Payer: Health EOS Commercial |
$65.86
|
Rate for Payer: HFN Commercial |
$68.08
|
Rate for Payer: Multiplan Commercial |
$59.20
|
Rate for Payer: NAPHCARE Commercial |
$44.40
|
Rate for Payer: Preferred Network Access Commercial |
$68.08
|
Rate for Payer: Quartz Beloit One Network |
$36.26
|
Rate for Payer: Quartz Commercial |
$44.40
|
Rate for Payer: WEA Trust Commercial |
$40.70
|
Rate for Payer: WPS Commercial |
$54.81
|
|
SLING STRAP ARM LARGE W/ PAD 8006-04
|
Facility
|
OP
|
$74.00
|
|
Hospital Charge Code |
2964021
|
Hospital Revenue Code
|
271
|
Min. Negotiated Rate |
$20.72 |
Max. Negotiated Rate |
$296.00 |
Rate for Payer: Aetna Commercial |
$66.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
Rate for Payer: Aetna Managed Medicare |
$20.72
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.10
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.52
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
Rate for Payer: Cash Price |
$22.20
|
Rate for Payer: Cigna Commercial |
$68.08
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
Rate for Payer: Health EOS Commercial |
$65.86
|
Rate for Payer: HFN Commercial |
$68.08
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.50
|
Rate for Payer: Multiplan Commercial |
$59.20
|
Rate for Payer: NAPHCARE Commercial |
$44.40
|
Rate for Payer: Preferred Network Access Commercial |
$68.08
|
Rate for Payer: Quartz Beloit One Network |
$36.26
|
Rate for Payer: Quartz Commercial |
$48.10
|
Rate for Payer: Quartz Medicare Advantage |
$44.40
|
Rate for Payer: The Alliance Commercial |
$296.00
|
Rate for Payer: WEA Trust Commercial |
$40.70
|
Rate for Payer: WPS Commercial |
$54.81
|
|