|
STRIP BLOOD LEAK TEST #5119
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
2971904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.64 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$276.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$552.88
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$642.20
|
| Rate for Payer: Quartz Medicare Advantage |
$592.80
|
| Rate for Payer: The Alliance Commercial |
$3,952.00
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
Strongyloides Antibody IgG
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5100606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Strongyloides Antibody IgG
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5100606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.60
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: HFN Commercial |
$119.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: The Alliance Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Strongyloides Antibody IgG
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5100606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.51
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Strontium-89
|
Professional
|
Both
|
$13,042.00
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
1486856
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$2,291.02 |
| Max. Negotiated Rate |
$12,389.90 |
| Rate for Payer: Aetna Commercial |
$12,389.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,216.12
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cigna Commercial |
$12,389.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,521.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,825.20
|
| Rate for Payer: Health EOS Commercial |
$11,868.22
|
| Rate for Payer: HFN Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,291.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,291.02
|
| Rate for Payer: Multiplan Commercial |
$10,433.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,389.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,738.48
|
| Rate for Payer: Quartz Commercial |
$7,433.94
|
| Rate for Payer: The Alliance Commercial |
$6,521.00
|
| Rate for Payer: WEA Trust Commercial |
$7,173.10
|
| Rate for Payer: WPS Commercial |
$9,660.21
|
|
|
Strontium-89
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
1486856
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,156.57 |
| Max. Negotiated Rate |
$16,626.29 |
| Rate for Payer: Aetna Commercial |
$11,737.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,216.12
|
| Rate for Payer: Aetna Managed Medicare |
$4,156.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,477.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,521.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,260.16
|
| Rate for Payer: Anthem Medicare Advantage |
$4,156.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,912.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,156.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,156.57
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cigna Commercial |
$11,998.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,156.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,298.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,156.57
|
| Rate for Payer: Health EOS Commercial |
$11,607.38
|
| Rate for Payer: HFN Commercial |
$11,998.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,462.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,156.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,156.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,156.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,156.57
|
| Rate for Payer: Multiplan Commercial |
$10,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,234.86
|
| Rate for Payer: Preferred Network Access Commercial |
$11,998.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,390.58
|
| Rate for Payer: Quartz Commercial |
$8,477.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,156.57
|
| Rate for Payer: The Alliance Commercial |
$16,626.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,156.57
|
| Rate for Payer: WEA Trust Commercial |
$7,173.10
|
| Rate for Payer: Wellcare Medicare |
$4,156.57
|
| Rate for Payer: WPS Commercial |
$9,660.21
|
|
|
Strontium-89
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
1486856
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$6,390.58 |
| Max. Negotiated Rate |
$11,998.64 |
| Rate for Payer: Aetna Commercial |
$11,737.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,216.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,912.26
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cigna Commercial |
$11,998.64
|
| Rate for Payer: Health EOS Commercial |
$11,607.38
|
| Rate for Payer: HFN Commercial |
$11,998.64
|
| Rate for Payer: Multiplan Commercial |
$10,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,825.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,998.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,390.58
|
| Rate for Payer: Quartz Commercial |
$7,825.20
|
| Rate for Payer: WEA Trust Commercial |
$7,173.10
|
| Rate for Payer: WPS Commercial |
$9,660.21
|
|
|
STRUT CONNECTING BOLT M6 NUT HOFFMANN LIMB 4933-1-702
|
Facility
|
IP
|
$368.00
|
|
| Hospital Charge Code |
5599714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$220.80
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
STRUT CONNECTING BOLT M6 NUT HOFFMANN LIMB 4933-1-702
|
Facility
|
OP
|
$368.00
|
|
| Hospital Charge Code |
5599714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$103.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.93
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$239.20
|
| Rate for Payer: Quartz Medicare Advantage |
$220.80
|
| Rate for Payer: The Alliance Commercial |
$1,472.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
STRUT HEXAPOD LONG 183MM - 295MM HOFFMANN LIMB 4935-0-040
|
Facility
|
IP
|
$10,592.00
|
|
| Hospital Charge Code |
6206986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,190.08 |
| Max. Negotiated Rate |
$9,744.64 |
| Rate for Payer: Aetna Commercial |
$9,532.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,109.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,613.76
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$9,744.64
|
| Rate for Payer: Health EOS Commercial |
$9,426.88
|
| Rate for Payer: HFN Commercial |
$9,744.64
|
| Rate for Payer: Multiplan Commercial |
$8,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,744.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,190.08
|
| Rate for Payer: Quartz Commercial |
$6,355.20
|
| Rate for Payer: WEA Trust Commercial |
$5,825.60
|
| Rate for Payer: WPS Commercial |
$7,845.49
|
|
|
STRUT HEXAPOD LONG 183MM - 295MM HOFFMANN LIMB 4935-0-040
|
Facility
|
OP
|
$10,592.00
|
|
| Hospital Charge Code |
6206986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,965.76 |
| Max. Negotiated Rate |
$42,368.00 |
| Rate for Payer: Aetna Commercial |
$9,532.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,109.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,965.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,884.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,296.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,084.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,613.76
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$9,744.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,927.28
|
| Rate for Payer: Health EOS Commercial |
$9,426.88
|
| Rate for Payer: HFN Commercial |
$9,744.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,944.00
|
| Rate for Payer: Multiplan Commercial |
$8,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,744.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,190.08
|
| Rate for Payer: Quartz Commercial |
$6,884.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,355.20
|
| Rate for Payer: The Alliance Commercial |
$42,368.00
|
| Rate for Payer: WEA Trust Commercial |
$5,825.60
|
| Rate for Payer: WPS Commercial |
$7,845.49
|
|
|
STRUT HEXAPOD MEDIUM 131MM - 191MM HOFFMANN LIMB 4935-0-030
|
Facility
|
OP
|
$10,592.00
|
|
| Hospital Charge Code |
6206985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,965.76 |
| Max. Negotiated Rate |
$42,368.00 |
| Rate for Payer: Aetna Commercial |
$9,532.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,109.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,965.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,884.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,296.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,084.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,613.76
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$9,744.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,927.28
|
| Rate for Payer: Health EOS Commercial |
$9,426.88
|
| Rate for Payer: HFN Commercial |
$9,744.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,944.00
|
| Rate for Payer: Multiplan Commercial |
$8,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,744.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,190.08
|
| Rate for Payer: Quartz Commercial |
$6,884.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,355.20
|
| Rate for Payer: The Alliance Commercial |
$42,368.00
|
| Rate for Payer: WEA Trust Commercial |
$5,825.60
|
| Rate for Payer: WPS Commercial |
$7,845.49
|
|
|
STRUT HEXAPOD MEDIUM 131MM - 191MM HOFFMANN LIMB 4935-0-030
|
Facility
|
IP
|
$10,592.00
|
|
| Hospital Charge Code |
6206985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,190.08 |
| Max. Negotiated Rate |
$9,744.64 |
| Rate for Payer: Aetna Commercial |
$9,532.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,109.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,613.76
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$9,744.64
|
| Rate for Payer: Health EOS Commercial |
$9,426.88
|
| Rate for Payer: HFN Commercial |
$9,744.64
|
| Rate for Payer: Multiplan Commercial |
$8,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,744.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,190.08
|
| Rate for Payer: Quartz Commercial |
$6,355.20
|
| Rate for Payer: WEA Trust Commercial |
$5,825.60
|
| Rate for Payer: WPS Commercial |
$7,845.49
|
|
|
STRUT STATIC LONG 60MM HOFFMANN LIMB 4933-1-560
|
Facility
|
OP
|
$1,196.00
|
|
| Hospital Charge Code |
5599707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.88 |
| Max. Negotiated Rate |
$4,784.00 |
| Rate for Payer: Aetna Commercial |
$1,076.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,028.56
|
| Rate for Payer: Aetna Managed Medicare |
$334.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$777.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$598.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$574.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$633.88
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$1,100.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$669.28
|
| Rate for Payer: Health EOS Commercial |
$1,064.44
|
| Rate for Payer: HFN Commercial |
$1,100.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.00
|
| Rate for Payer: Multiplan Commercial |
$956.80
|
| Rate for Payer: NAPHCARE Commercial |
$717.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,100.32
|
| Rate for Payer: Quartz Beloit One Network |
$586.04
|
| Rate for Payer: Quartz Commercial |
$777.40
|
| Rate for Payer: Quartz Medicare Advantage |
$717.60
|
| Rate for Payer: The Alliance Commercial |
$4,784.00
|
| Rate for Payer: WEA Trust Commercial |
$657.80
|
| Rate for Payer: WPS Commercial |
$885.88
|
|
|
STRUT STATIC LONG 60MM HOFFMANN LIMB 4933-1-560
|
Facility
|
IP
|
$1,196.00
|
|
| Hospital Charge Code |
5599707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.04 |
| Max. Negotiated Rate |
$1,100.32 |
| Rate for Payer: Aetna Commercial |
$1,076.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,028.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$633.88
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$1,100.32
|
| Rate for Payer: Health EOS Commercial |
$1,064.44
|
| Rate for Payer: HFN Commercial |
$1,100.32
|
| Rate for Payer: Multiplan Commercial |
$956.80
|
| Rate for Payer: NAPHCARE Commercial |
$717.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,100.32
|
| Rate for Payer: Quartz Beloit One Network |
$586.04
|
| Rate for Payer: Quartz Commercial |
$717.60
|
| Rate for Payer: WEA Trust Commercial |
$657.80
|
| Rate for Payer: WPS Commercial |
$885.88
|
|
|
STRUT STATIC MEDIUM 40MM HOFFMANN LIMB 4933-1-540
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
5599706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
STRUT STATIC MEDIUM 40MM HOFFMANN LIMB 4933-1-540
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
5599706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
STRUT TELESCOPIC EXTRA SHORT BLACK 100-125MM HOFFMANN LIMB 4933-0-100
|
Facility
|
IP
|
$7,242.00
|
|
| Hospital Charge Code |
6065668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,548.58 |
| Max. Negotiated Rate |
$6,662.64 |
| Rate for Payer: Aetna Commercial |
$6,517.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,228.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,838.26
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,662.64
|
| Rate for Payer: Health EOS Commercial |
$6,445.38
|
| Rate for Payer: HFN Commercial |
$6,662.64
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,662.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,548.58
|
| Rate for Payer: Quartz Commercial |
$4,345.20
|
| Rate for Payer: WEA Trust Commercial |
$3,983.10
|
| Rate for Payer: WPS Commercial |
$5,364.15
|
|
|
STRUT TELESCOPIC EXTRA SHORT BLACK 100-125MM HOFFMANN LIMB 4933-0-100
|
Facility
|
OP
|
$7,242.00
|
|
| Hospital Charge Code |
6065668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,027.76 |
| Max. Negotiated Rate |
$28,968.00 |
| Rate for Payer: Aetna Commercial |
$6,517.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,228.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,027.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,707.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,476.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,838.26
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,662.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,052.62
|
| Rate for Payer: Health EOS Commercial |
$6,445.38
|
| Rate for Payer: HFN Commercial |
$6,662.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,431.50
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,662.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,548.58
|
| Rate for Payer: Quartz Commercial |
$4,707.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,345.20
|
| Rate for Payer: The Alliance Commercial |
$28,968.00
|
| Rate for Payer: WEA Trust Commercial |
$3,983.10
|
| Rate for Payer: WPS Commercial |
$5,364.15
|
|
|
STRUT TELESCOPIC LONG RED 177-277MM HOFFMANN LIMB 4933-0-180
|
Facility
|
IP
|
$7,242.00
|
|
| Hospital Charge Code |
6065669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,548.58 |
| Max. Negotiated Rate |
$6,662.64 |
| Rate for Payer: Aetna Commercial |
$6,517.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,228.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,838.26
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,662.64
|
| Rate for Payer: Health EOS Commercial |
$6,445.38
|
| Rate for Payer: HFN Commercial |
$6,662.64
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,662.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,548.58
|
| Rate for Payer: Quartz Commercial |
$4,345.20
|
| Rate for Payer: WEA Trust Commercial |
$3,983.10
|
| Rate for Payer: WPS Commercial |
$5,364.15
|
|
|
STRUT TELESCOPIC LONG RED 177-277MM HOFFMANN LIMB 4933-0-180
|
Facility
|
OP
|
$7,242.00
|
|
| Hospital Charge Code |
6065669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,027.76 |
| Max. Negotiated Rate |
$28,968.00 |
| Rate for Payer: Aetna Commercial |
$6,517.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,228.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,027.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,707.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,476.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,838.26
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,662.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,052.62
|
| Rate for Payer: Health EOS Commercial |
$6,445.38
|
| Rate for Payer: HFN Commercial |
$6,662.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,431.50
|
| Rate for Payer: Multiplan Commercial |
$5,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,662.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,548.58
|
| Rate for Payer: Quartz Commercial |
$4,707.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,345.20
|
| Rate for Payer: The Alliance Commercial |
$28,968.00
|
| Rate for Payer: WEA Trust Commercial |
$3,983.10
|
| Rate for Payer: WPS Commercial |
$5,364.15
|
|
|
STRUT TELESCOPIC MEDIUM BLUE 138-201MM HOFFMANN LIMB 4933-0-140
|
Facility
|
IP
|
$7,833.00
|
|
| Hospital Charge Code |
5599705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,838.17 |
| Max. Negotiated Rate |
$7,206.36 |
| Rate for Payer: Aetna Commercial |
$7,049.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,736.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,151.49
|
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: Cigna Commercial |
$7,206.36
|
| Rate for Payer: Health EOS Commercial |
$6,971.37
|
| Rate for Payer: HFN Commercial |
$7,206.36
|
| Rate for Payer: Multiplan Commercial |
$6,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,699.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,206.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,838.17
|
| Rate for Payer: Quartz Commercial |
$4,699.80
|
| Rate for Payer: WEA Trust Commercial |
$4,308.15
|
| Rate for Payer: WPS Commercial |
$5,801.90
|
|
|
STRUT TELESCOPIC MEDIUM BLUE 138-201MM HOFFMANN LIMB 4933-0-140
|
Facility
|
OP
|
$7,833.00
|
|
| Hospital Charge Code |
5599705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,193.24 |
| Max. Negotiated Rate |
$31,332.00 |
| Rate for Payer: Aetna Commercial |
$7,049.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,736.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,193.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,091.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,916.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,759.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,151.49
|
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: Cigna Commercial |
$7,206.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,383.35
|
| Rate for Payer: Health EOS Commercial |
$6,971.37
|
| Rate for Payer: HFN Commercial |
$7,206.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,874.75
|
| Rate for Payer: Multiplan Commercial |
$6,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,699.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,206.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,838.17
|
| Rate for Payer: Quartz Commercial |
$5,091.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,699.80
|
| Rate for Payer: The Alliance Commercial |
$31,332.00
|
| Rate for Payer: WEA Trust Commercial |
$4,308.15
|
| Rate for Payer: WPS Commercial |
$5,801.90
|
|
|
STRYKER REUNION REVERSE TOTAL SHOULDER IMPLANTS (INCLUDES: GLENOSPHERE,GLENOID BASEPLATE, HUMERAL ST
|
Facility
|
OP
|
$41,801.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,704.28 |
| Max. Negotiated Rate |
$167,204.00 |
| Rate for Payer: Aetna Commercial |
$37,620.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,948.86
|
| Rate for Payer: Aetna Managed Medicare |
$11,704.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,170.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,900.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,064.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,154.53
|
| Rate for Payer: Cash Price |
$12,540.30
|
| Rate for Payer: Cigna Commercial |
$38,456.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,391.84
|
| Rate for Payer: Health EOS Commercial |
$37,202.89
|
| Rate for Payer: HFN Commercial |
$38,456.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,350.75
|
| Rate for Payer: Multiplan Commercial |
$33,440.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,080.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,456.92
|
| Rate for Payer: Quartz Beloit One Network |
$20,482.49
|
| Rate for Payer: Quartz Commercial |
$27,170.65
|
| Rate for Payer: Quartz Medicare Advantage |
$25,080.60
|
| Rate for Payer: The Alliance Commercial |
$167,204.00
|
| Rate for Payer: WEA Trust Commercial |
$22,990.55
|
| Rate for Payer: WPS Commercial |
$30,962.00
|
|
|
STRYKER REUNION REVERSE TOTAL SHOULDER IMPLANTS (INCLUDES: GLENOSPHERE,GLENOID BASEPLATE, HUMERAL ST
|
Facility
|
IP
|
$41,801.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,482.49 |
| Max. Negotiated Rate |
$38,456.92 |
| Rate for Payer: Aetna Commercial |
$37,620.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,948.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,154.53
|
| Rate for Payer: Cash Price |
$12,540.30
|
| Rate for Payer: Cigna Commercial |
$38,456.92
|
| Rate for Payer: Health EOS Commercial |
$37,202.89
|
| Rate for Payer: HFN Commercial |
$38,456.92
|
| Rate for Payer: Multiplan Commercial |
$33,440.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,080.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,456.92
|
| Rate for Payer: Quartz Beloit One Network |
$20,482.49
|
| Rate for Payer: Quartz Commercial |
$25,080.60
|
| Rate for Payer: WEA Trust Commercial |
$22,990.55
|
| Rate for Payer: WPS Commercial |
$30,962.00
|
|
