|
STEM STD OFFSE TRABEC 18MM 007864-18-00
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM STD OFFSE TRABEC 18MM 007864-18-00
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM STD OFFSET TRABEC 14MM 00-7864-014-00
|
Facility
OP
|
$26,131.00
|
|
| Hospital Charge Code |
2967848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,316.68 |
| Max. Negotiated Rate |
$104,524.00 |
| Rate for Payer: Aetna Commercial |
$23,517.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,472.66
|
| Rate for Payer: Aetna Managed Medicare |
$7,316.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,985.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,065.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,542.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,849.43
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$24,040.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,622.91
|
| Rate for Payer: Health EOS Commercial |
$23,256.59
|
| Rate for Payer: HFN Commercial |
$24,040.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,598.25
|
| Rate for Payer: Multiplan Commercial |
$20,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,678.60
|
| Rate for Payer: Preferred Network Access Commercial |
$24,040.52
|
| Rate for Payer: Quartz Beloit One Network |
$12,804.19
|
| Rate for Payer: Quartz Commercial |
$16,985.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15,678.60
|
| Rate for Payer: The Alliance Commercial |
$104,524.00
|
| Rate for Payer: WEA Trust Commercial |
$14,372.05
|
| Rate for Payer: WPS Commercial |
$19,355.23
|
|
|
STEM STD OFFSET TRABEC 14MM 00-7864-014-00
|
Facility
IP
|
$26,131.00
|
|
| Hospital Charge Code |
2967848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,804.19 |
| Max. Negotiated Rate |
$24,040.52 |
| Rate for Payer: Aetna Commercial |
$23,517.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,849.43
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$24,040.52
|
| Rate for Payer: Health EOS Commercial |
$23,256.59
|
| Rate for Payer: HFN Commercial |
$24,040.52
|
| Rate for Payer: Multiplan Commercial |
$20,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,678.60
|
| Rate for Payer: Preferred Network Access Commercial |
$24,040.52
|
| Rate for Payer: Quartz Beloit One Network |
$12,804.19
|
| Rate for Payer: Quartz Commercial |
$15,678.60
|
| Rate for Payer: WEA Trust Commercial |
$14,372.05
|
| Rate for Payer: WPS Commercial |
$19,355.23
|
|
|
STEM STD OFFSET TRABEC 9MM 00-7864-09-00
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM STD OFFSET TRABEC 9MM 00-7864-09-00
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 100MM 5560-S-212
|
Facility
OP
|
$6,609.00
|
|
| Hospital Charge Code |
3983347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.52 |
| Max. Negotiated Rate |
$26,436.00 |
| Rate for Payer: Aetna Commercial |
$5,948.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,683.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,850.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,295.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,304.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,172.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,502.77
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,080.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,698.40
|
| Rate for Payer: Health EOS Commercial |
$5,882.01
|
| Rate for Payer: HFN Commercial |
$6,080.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,956.75
|
| Rate for Payer: Multiplan Commercial |
$5,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,965.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,238.41
|
| Rate for Payer: Quartz Commercial |
$4,295.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,965.40
|
| Rate for Payer: The Alliance Commercial |
$26,436.00
|
| Rate for Payer: WEA Trust Commercial |
$3,634.95
|
| Rate for Payer: WPS Commercial |
$4,895.29
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 100MM 5560-S-212
|
Facility
IP
|
$6,609.00
|
|
| Hospital Charge Code |
3983347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.41 |
| Max. Negotiated Rate |
$6,080.28 |
| Rate for Payer: Aetna Commercial |
$5,948.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,502.77
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,080.28
|
| Rate for Payer: Health EOS Commercial |
$5,882.01
|
| Rate for Payer: HFN Commercial |
$6,080.28
|
| Rate for Payer: Multiplan Commercial |
$5,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,965.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,238.41
|
| Rate for Payer: Quartz Commercial |
$3,965.40
|
| Rate for Payer: WEA Trust Commercial |
$3,634.95
|
| Rate for Payer: WPS Commercial |
$4,895.29
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 50MM 5560-S-112
|
Facility
OP
|
$6,864.00
|
|
| Hospital Charge Code |
4100375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.92 |
| Max. Negotiated Rate |
$27,456.00 |
| Rate for Payer: Aetna Commercial |
$6,177.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,903.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,921.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,461.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,432.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,637.92
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna Commercial |
$6,314.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,841.09
|
| Rate for Payer: Health EOS Commercial |
$6,108.96
|
| Rate for Payer: HFN Commercial |
$6,314.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,148.00
|
| Rate for Payer: Multiplan Commercial |
$5,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,314.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,363.36
|
| Rate for Payer: Quartz Commercial |
$4,461.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,118.40
|
| Rate for Payer: The Alliance Commercial |
$27,456.00
|
| Rate for Payer: WEA Trust Commercial |
$3,775.20
|
| Rate for Payer: WPS Commercial |
$5,084.16
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 50MM 5560-S-112
|
Facility
IP
|
$6,864.00
|
|
| Hospital Charge Code |
4100375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,363.36 |
| Max. Negotiated Rate |
$6,314.88 |
| Rate for Payer: Aetna Commercial |
$6,177.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,637.92
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna Commercial |
$6,314.88
|
| Rate for Payer: Health EOS Commercial |
$6,108.96
|
| Rate for Payer: HFN Commercial |
$6,314.88
|
| Rate for Payer: Multiplan Commercial |
$5,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,314.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,363.36
|
| Rate for Payer: Quartz Commercial |
$4,118.40
|
| Rate for Payer: WEA Trust Commercial |
$3,775.20
|
| Rate for Payer: WPS Commercial |
$5,084.16
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 15MM X 50MM 5560-S-115
|
Facility
OP
|
$6,609.00
|
|
| Hospital Charge Code |
3827377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.52 |
| Max. Negotiated Rate |
$26,436.00 |
| Rate for Payer: Aetna Commercial |
$5,948.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,683.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,850.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,295.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,304.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,172.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,502.77
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,080.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,698.40
|
| Rate for Payer: Health EOS Commercial |
$5,882.01
|
| Rate for Payer: HFN Commercial |
$6,080.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,956.75
|
| Rate for Payer: Multiplan Commercial |
$5,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,965.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,238.41
|
| Rate for Payer: Quartz Commercial |
$4,295.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,965.40
|
| Rate for Payer: The Alliance Commercial |
$26,436.00
|
| Rate for Payer: WEA Trust Commercial |
$3,634.95
|
| Rate for Payer: WPS Commercial |
$4,895.29
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 15MM X 50MM 5560-S-115
|
Facility
IP
|
$6,609.00
|
|
| Hospital Charge Code |
3827377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.41 |
| Max. Negotiated Rate |
$6,080.28 |
| Rate for Payer: Aetna Commercial |
$5,948.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,502.77
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,080.28
|
| Rate for Payer: Health EOS Commercial |
$5,882.01
|
| Rate for Payer: HFN Commercial |
$6,080.28
|
| Rate for Payer: Multiplan Commercial |
$5,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,965.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,238.41
|
| Rate for Payer: Quartz Commercial |
$3,965.40
|
| Rate for Payer: WEA Trust Commercial |
$3,634.95
|
| Rate for Payer: WPS Commercial |
$4,895.29
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 9MM X 100MM 5560-S-209
|
Facility
IP
|
$6,609.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3827374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.41 |
| Max. Negotiated Rate |
$6,080.28 |
| Rate for Payer: Aetna Commercial |
$5,948.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,502.77
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,080.28
|
| Rate for Payer: Health EOS Commercial |
$5,882.01
|
| Rate for Payer: HFN Commercial |
$6,080.28
|
| Rate for Payer: Multiplan Commercial |
$5,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,965.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,238.41
|
| Rate for Payer: Quartz Commercial |
$3,965.40
|
| Rate for Payer: WEA Trust Commercial |
$3,634.95
|
| Rate for Payer: WPS Commercial |
$4,895.29
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 9MM X 100MM 5560-S-209
|
Facility
OP
|
$6,609.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3827374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,850.52 |
| Max. Negotiated Rate |
$6,080.28 |
| Rate for Payer: Aetna Commercial |
$5,948.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,683.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,850.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,295.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,304.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,172.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,502.77
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,080.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,698.40
|
| Rate for Payer: Health EOS Commercial |
$5,882.01
|
| Rate for Payer: HFN Commercial |
$6,080.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,956.75
|
| Rate for Payer: Multiplan Commercial |
$5,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,965.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,238.41
|
| Rate for Payer: Quartz Commercial |
$4,295.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,965.40
|
| Rate for Payer: WEA Trust Commercial |
$3,634.95
|
| Rate for Payer: WPS Commercial |
$4,895.29
|
|
|
STEM UNIVERSAL FLUTED 75MM X 14MM 86-7414
|
Facility
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
STEM UNIVERSAL FLUTED 75MM X 14MM 86-7414
|
Facility
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
STEM UNIVERSAL FLUTED 75MM X 16MM 86-7416
|
Facility
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
STEM UNIVERSAL FLUTED 75MM X 16MM 86-7416
|
Facility
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
Stenger Test, Pure Tone
|
Professional
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
1188818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$140.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$134.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$140.60
|
| Rate for Payer: Quartz Beloit One Network |
$65.12
|
| Rate for Payer: Quartz Commercial |
$84.36
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$47.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$76.40
|
|
|
Stenger Test, Pure Tone
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
1188818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Stenger Test, Pure Tone
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
1188818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Stenger Test-Pure Tone
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
3203501
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Stenger Test-Pure Tone
|
Professional
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
3203501
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$140.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$134.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$140.60
|
| Rate for Payer: Quartz Beloit One Network |
$65.12
|
| Rate for Payer: Quartz Commercial |
$84.36
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$47.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$76.40
|
|
|
Stenger Test-Pure Tone
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
3203501
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
STENT 10 X 37mm 80cm PXB35-10-37
|
Facility
OP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.76 |
| Max. Negotiated Rate |
$5,926.64 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,187.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,092.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.94
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.50
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$4,187.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.20
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
