|
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 |
$348.28 |
| Max. Negotiated Rate |
$1,144.33 |
| Rate for Payer: Aetna Commercial |
$1,119.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,069.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$808.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.24
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$1,144.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.07
|
| Rate for Payer: Health EOS Commercial |
$1,107.02
|
| Rate for Payer: HFN Commercial |
$1,144.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$932.88
|
| Rate for Payer: Multiplan Commercial |
$995.07
|
| Rate for Payer: NAPHCARE Commercial |
$746.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.33
|
| Rate for Payer: Quartz Beloit One Network |
$609.48
|
| Rate for Payer: Quartz Commercial |
$808.50
|
| Rate for Payer: Quartz Medicare Advantage |
$746.30
|
| Rate for Payer: The Alliance Commercial |
$621.92
|
| Rate for Payer: WEA Trust Commercial |
$684.11
|
| Rate for Payer: WPS Commercial |
$921.28
|
|
|
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 |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
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 |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
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 |
$3,690.52 |
| Max. Negotiated Rate |
$6,929.15 |
| Rate for Payer: Aetna Commercial |
$6,778.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,477.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,991.79
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,929.15
|
| Rate for Payer: Health EOS Commercial |
$6,703.20
|
| Rate for Payer: HFN Commercial |
$6,929.15
|
| Rate for Payer: Multiplan Commercial |
$6,025.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,929.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,690.52
|
| Rate for Payer: Quartz Commercial |
$4,519.01
|
| Rate for Payer: WEA Trust Commercial |
$4,142.42
|
| Rate for Payer: WPS Commercial |
$5,578.51
|
|
|
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 |
$2,108.87 |
| Max. Negotiated Rate |
$6,929.15 |
| Rate for Payer: Aetna Commercial |
$6,778.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,477.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,108.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,895.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,765.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,615.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,991.79
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,929.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,214.84
|
| Rate for Payer: Health EOS Commercial |
$6,703.20
|
| Rate for Payer: HFN Commercial |
$6,929.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,648.76
|
| Rate for Payer: Multiplan Commercial |
$6,025.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,519.01
|
| Rate for Payer: Preferred Network Access Commercial |
$6,929.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,690.52
|
| Rate for Payer: Quartz Commercial |
$4,895.59
|
| Rate for Payer: Quartz Medicare Advantage |
$4,519.01
|
| Rate for Payer: The Alliance Commercial |
$3,765.84
|
| Rate for Payer: WEA Trust Commercial |
$4,142.42
|
| Rate for Payer: WPS Commercial |
$5,578.51
|
|
|
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 |
$3,690.52 |
| Max. Negotiated Rate |
$6,929.15 |
| Rate for Payer: Aetna Commercial |
$6,778.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,477.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,991.79
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,929.15
|
| Rate for Payer: Health EOS Commercial |
$6,703.20
|
| Rate for Payer: HFN Commercial |
$6,929.15
|
| Rate for Payer: Multiplan Commercial |
$6,025.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,929.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,690.52
|
| Rate for Payer: Quartz Commercial |
$4,519.01
|
| Rate for Payer: WEA Trust Commercial |
$4,142.42
|
| Rate for Payer: WPS Commercial |
$5,578.51
|
|
|
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 |
$2,108.87 |
| Max. Negotiated Rate |
$6,929.15 |
| Rate for Payer: Aetna Commercial |
$6,778.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,477.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,108.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,895.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,765.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,615.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,991.79
|
| Rate for Payer: Cash Price |
$2,172.60
|
| Rate for Payer: Cigna Commercial |
$6,929.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,214.84
|
| Rate for Payer: Health EOS Commercial |
$6,703.20
|
| Rate for Payer: HFN Commercial |
$6,929.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,648.76
|
| Rate for Payer: Multiplan Commercial |
$6,025.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,519.01
|
| Rate for Payer: Preferred Network Access Commercial |
$6,929.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,690.52
|
| Rate for Payer: Quartz Commercial |
$4,895.59
|
| Rate for Payer: Quartz Medicare Advantage |
$4,519.01
|
| Rate for Payer: The Alliance Commercial |
$3,765.84
|
| Rate for Payer: WEA Trust Commercial |
$4,142.42
|
| Rate for Payer: WPS Commercial |
$5,578.51
|
|
|
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 |
$3,991.70 |
| Max. Negotiated Rate |
$7,494.61 |
| Rate for Payer: Aetna Commercial |
$7,331.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,005.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,317.55
|
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: Cigna Commercial |
$7,494.61
|
| Rate for Payer: Health EOS Commercial |
$7,250.22
|
| Rate for Payer: HFN Commercial |
$7,494.61
|
| Rate for Payer: Multiplan Commercial |
$6,517.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,494.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,991.70
|
| Rate for Payer: Quartz Commercial |
$4,887.79
|
| Rate for Payer: WEA Trust Commercial |
$4,480.48
|
| Rate for Payer: WPS Commercial |
$6,033.76
|
|
|
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 |
$2,280.97 |
| Max. Negotiated Rate |
$7,494.61 |
| Rate for Payer: Aetna Commercial |
$7,331.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,005.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,280.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,295.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,073.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,910.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,317.55
|
| Rate for Payer: Cash Price |
$2,349.90
|
| Rate for Payer: Cigna Commercial |
$7,494.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,558.81
|
| Rate for Payer: Health EOS Commercial |
$7,250.22
|
| Rate for Payer: HFN Commercial |
$7,494.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,109.74
|
| Rate for Payer: Multiplan Commercial |
$6,517.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,887.79
|
| Rate for Payer: Preferred Network Access Commercial |
$7,494.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,991.70
|
| Rate for Payer: Quartz Commercial |
$5,295.11
|
| Rate for Payer: Quartz Medicare Advantage |
$4,887.79
|
| Rate for Payer: The Alliance Commercial |
$4,073.16
|
| Rate for Payer: WEA Trust Commercial |
$4,480.48
|
| Rate for Payer: WPS Commercial |
$6,033.76
|
|
|
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 |
$12,172.45 |
| Max. Negotiated Rate |
$39,995.20 |
| Rate for Payer: Aetna Commercial |
$39,125.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,386.81
|
| Rate for Payer: Aetna Managed Medicare |
$12,172.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,257.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,736.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,867.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,040.71
|
| Rate for Payer: Cash Price |
$12,540.30
|
| Rate for Payer: Cigna Commercial |
$39,995.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,328.18
|
| Rate for Payer: Health EOS Commercial |
$38,691.01
|
| Rate for Payer: HFN Commercial |
$39,995.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,604.78
|
| Rate for Payer: Multiplan Commercial |
$34,778.43
|
| Rate for Payer: NAPHCARE Commercial |
$26,083.82
|
| Rate for Payer: Preferred Network Access Commercial |
$39,995.20
|
| Rate for Payer: Quartz Beloit One Network |
$21,301.79
|
| Rate for Payer: Quartz Commercial |
$28,257.48
|
| Rate for Payer: Quartz Medicare Advantage |
$26,083.82
|
| Rate for Payer: The Alliance Commercial |
$21,736.52
|
| Rate for Payer: WEA Trust Commercial |
$23,910.17
|
| Rate for Payer: WPS Commercial |
$32,199.31
|
|
|
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 |
$21,301.79 |
| Max. Negotiated Rate |
$39,995.20 |
| Rate for Payer: Aetna Commercial |
$39,125.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,386.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,040.71
|
| Rate for Payer: Cash Price |
$12,540.30
|
| Rate for Payer: Cigna Commercial |
$39,995.20
|
| Rate for Payer: Health EOS Commercial |
$38,691.01
|
| Rate for Payer: HFN Commercial |
$39,995.20
|
| Rate for Payer: Multiplan Commercial |
$34,778.43
|
| Rate for Payer: Preferred Network Access Commercial |
$39,995.20
|
| Rate for Payer: Quartz Beloit One Network |
$21,301.79
|
| Rate for Payer: Quartz Commercial |
$26,083.82
|
| Rate for Payer: WEA Trust Commercial |
$23,910.17
|
| Rate for Payer: WPS Commercial |
$32,199.31
|
|
|
STYLET FALLER TUNNELLING 8888415679
|
Facility
|
OP
|
$2,637.00
|
|
| Hospital Charge Code |
4520283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$767.89 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Aetna Managed Medicare |
$767.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.73
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,056.86
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,782.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.49
|
| Rate for Payer: The Alliance Commercial |
$1,371.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
STYLET FALLER TUNNELLING 8888415679
|
Facility
|
IP
|
$2,637.00
|
|
| Hospital Charge Code |
4520283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,343.82 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,645.49
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
STYLET INTUBATING SZ 5.0-10MM #85865
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2974644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
STYLET INTUBATING SZ 5.0-10MM #85865
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2974644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
STYLET SATIN SLIP-ADULT 10FR 5-15101
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
STYLET SATIN SLIP-ADULT 10FR 5-15101
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
STYLET SATIN SLIP -PEDS 6FR DYND43506***DEDE 10/23
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2963540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
STYLET SATIN SLIP -PEDS 6FR DYND43506***DEDE 10/23
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2963540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
STYLET SPRING WIRE GUIDE
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
2962948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
STYLET SPRING WIRE GUIDE
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
2962948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
SUBACROMIAL DECOMPRESSION
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
SUBACROMIAL DECOMPRESSION
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
Subconjunctival Injection
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
1188934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$28.75
|
| Rate for Payer: Anthem Medicare Advantage |
$28.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.75
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$311.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.75
|
| Rate for Payer: Health EOS Commercial |
$298.12
|
| Rate for Payer: HFN Commercial |
$311.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$43.12
|
| Rate for Payer: Preferred Network Access Commercial |
$311.22
|
| Rate for Payer: Quartz Beloit One Network |
$144.14
|
| Rate for Payer: Quartz Commercial |
$186.73
|
| Rate for Payer: Quartz Medicare Advantage |
$28.75
|
| Rate for Payer: The Alliance Commercial |
$122.17
|
| Rate for Payer: United Healthcare Medicaid |
$30.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.75
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$129.36
|
|
|
Subconjunctival Injenction 6820050
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
CPT 68200 50
|
| Hospital Charge Code |
5438754
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$585.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.38
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$585.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$370.03
|
| Rate for Payer: Health EOS Commercial |
$561.22
|
| Rate for Payer: HFN Commercial |
$585.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.79
|
| Rate for Payer: Multiplan Commercial |
$493.38
|
| Rate for Payer: Preferred Network Access Commercial |
$585.88
|
| Rate for Payer: Quartz Beloit One Network |
$271.36
|
| Rate for Payer: Quartz Commercial |
$351.53
|
| Rate for Payer: The Alliance Commercial |
$308.36
|
| Rate for Payer: United Healthcare Medicaid |
$30.70
|
| Rate for Payer: WEA Trust Commercial |
$339.20
|
| Rate for Payer: WPS Commercial |
$456.79
|
|
