|
SYSTEM STRATOS ENDOSCOPIC CARPAL TUNNEL RELEASE 5500
|
Facility
|
OP
|
$9,102.00
|
|
| Hospital Charge Code |
4508723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,650.50 |
| Max. Negotiated Rate |
$8,708.79 |
| Rate for Payer: Aetna Commercial |
$8,519.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,140.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,650.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,152.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,733.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,543.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,017.02
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,708.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,297.36
|
| Rate for Payer: Health EOS Commercial |
$8,424.81
|
| Rate for Payer: HFN Commercial |
$8,708.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,099.56
|
| Rate for Payer: Multiplan Commercial |
$7,572.86
|
| Rate for Payer: NAPHCARE Commercial |
$5,679.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,708.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,638.38
|
| Rate for Payer: Quartz Commercial |
$6,152.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,679.65
|
| Rate for Payer: The Alliance Commercial |
$4,733.04
|
| Rate for Payer: WEA Trust Commercial |
$5,206.34
|
| Rate for Payer: WPS Commercial |
$7,011.27
|
|
|
SYSTEM THROMBINATOR (DISP) ABS-10080
|
Facility
|
OP
|
$2,174.00
|
|
| Hospital Charge Code |
6234191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.07 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Aetna Managed Medicare |
$633.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,469.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,130.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.27
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.72
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,469.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.58
|
| Rate for Payer: The Alliance Commercial |
$1,130.48
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
|
SYSTEM THROMBINATOR (DISP) ABS-10080
|
Facility
|
IP
|
$2,174.00
|
|
| Hospital Charge Code |
6234191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.87 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,356.58
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
|
SYS TRANSFER PREVALON 3242
|
Facility
|
IP
|
$1,581.00
|
|
| Hospital Charge Code |
5414961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$805.68 |
| Max. Negotiated Rate |
$1,512.70 |
| Rate for Payer: Aetna Commercial |
$1,479.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.45
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,512.70
|
| Rate for Payer: Health EOS Commercial |
$1,463.37
|
| Rate for Payer: HFN Commercial |
$1,512.70
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.70
|
| Rate for Payer: Quartz Beloit One Network |
$805.68
|
| Rate for Payer: Quartz Commercial |
$986.54
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$1,217.84
|
|
|
SYS TRANSFER PREVALON 3242
|
Facility
|
OP
|
$1,581.00
|
|
| Hospital Charge Code |
5414961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.39 |
| Max. Negotiated Rate |
$1,512.70 |
| Rate for Payer: Aetna Commercial |
$1,479.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Aetna Managed Medicare |
$460.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,068.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$822.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$789.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.45
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,512.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$920.14
|
| Rate for Payer: Health EOS Commercial |
$1,463.37
|
| Rate for Payer: HFN Commercial |
$1,512.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.18
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: NAPHCARE Commercial |
$986.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.70
|
| Rate for Payer: Quartz Beloit One Network |
$805.68
|
| Rate for Payer: Quartz Commercial |
$1,068.76
|
| Rate for Payer: Quartz Medicare Advantage |
$986.54
|
| Rate for Payer: The Alliance Commercial |
$822.12
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$1,217.84
|
|
|
SYS XXL REPOSITIONER PREVALON AIRTAP 7231
|
Facility
|
OP
|
$4,296.00
|
|
| Hospital Charge Code |
5414962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$4,110.41 |
| Rate for Payer: Aetna Commercial |
$4,021.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,842.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,904.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,233.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,144.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,367.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$4,110.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,500.27
|
| Rate for Payer: Health EOS Commercial |
$3,976.38
|
| Rate for Payer: HFN Commercial |
$4,110.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,350.88
|
| Rate for Payer: Multiplan Commercial |
$3,574.27
|
| Rate for Payer: NAPHCARE Commercial |
$2,680.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,110.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.24
|
| Rate for Payer: Quartz Commercial |
$2,904.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,680.70
|
| Rate for Payer: The Alliance Commercial |
$2,233.92
|
| Rate for Payer: WEA Trust Commercial |
$2,457.31
|
| Rate for Payer: WPS Commercial |
$3,309.21
|
|
|
SYS XXL REPOSITIONER PREVALON AIRTAP 7231
|
Facility
|
IP
|
$4,296.00
|
|
| Hospital Charge Code |
5414962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,189.24 |
| Max. Negotiated Rate |
$4,110.41 |
| Rate for Payer: Aetna Commercial |
$4,021.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,842.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,367.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$4,110.41
|
| Rate for Payer: Health EOS Commercial |
$3,976.38
|
| Rate for Payer: HFN Commercial |
$4,110.41
|
| Rate for Payer: Multiplan Commercial |
$3,574.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,110.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.24
|
| Rate for Payer: Quartz Commercial |
$2,680.70
|
| Rate for Payer: WEA Trust Commercial |
$2,457.31
|
| Rate for Payer: WPS Commercial |
$3,309.21
|
|
|
T3 Free
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
633834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$207.48 |
| Rate for Payer: Aetna Commercial |
$207.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$207.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$198.74
|
| Rate for Payer: HFN Commercial |
$207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$207.48
|
| Rate for Payer: Quartz Beloit One Network |
$96.10
|
| Rate for Payer: Quartz Commercial |
$124.49
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$69.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$77.52
|
|
|
T3 Free
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
633834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
T3 Free
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
633834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.25
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: United Healthcare PPO |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: Wellcare Medicare |
$17.62
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
T3 Resin Uptake
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
633835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
T3 Resin Uptake
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
633835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$144.25 |
| Rate for Payer: Aetna Commercial |
$144.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$144.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$138.17
|
| Rate for Payer: HFN Commercial |
$144.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$144.25
|
| Rate for Payer: Quartz Beloit One Network |
$66.81
|
| Rate for Payer: Quartz Commercial |
$86.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$29.61
|
|
|
T3 Resin Uptake
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
633835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.17
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare PPO |
$113.88
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: Wellcare Medicare |
$6.73
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
T3 Reverse
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
633836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$191.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$16.39
|
| Rate for Payer: Anthem Medicare Advantage |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.39
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$191.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.39
|
| Rate for Payer: Health EOS Commercial |
$183.60
|
| Rate for Payer: HFN Commercial |
$191.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$24.59
|
| Rate for Payer: Preferred Network Access Commercial |
$191.67
|
| Rate for Payer: Quartz Beloit One Network |
$88.77
|
| Rate for Payer: Quartz Commercial |
$115.00
|
| Rate for Payer: Quartz Medicare Advantage |
$16.39
|
| Rate for Payer: The Alliance Commercial |
$64.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.39
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$72.12
|
|
|
T3 Reverse
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
633836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
T3 Reverse
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
633836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$16.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.21
|
| Rate for Payer: Anthem Medicare Advantage |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.39
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.39
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$24.59
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$16.39
|
| Rate for Payer: The Alliance Commercial |
$65.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.39
|
| Rate for Payer: United Healthcare PPO |
$151.32
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: Wellcare Medicare |
$16.39
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
T4 Free, Direct Dialysis
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
983417
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$719.51 |
| Rate for Payer: Aetna Commercial |
$703.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.59
|
| Rate for Payer: Aetna Managed Medicare |
$9.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.57
|
| Rate for Payer: Anthem Medicare Advantage |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.38
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$719.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.38
|
| Rate for Payer: Health EOS Commercial |
$696.05
|
| Rate for Payer: HFN Commercial |
$719.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$625.66
|
| Rate for Payer: NAPHCARE Commercial |
$14.07
|
| Rate for Payer: Preferred Network Access Commercial |
$719.51
|
| Rate for Payer: Quartz Beloit One Network |
$383.22
|
| Rate for Payer: Quartz Commercial |
$508.35
|
| Rate for Payer: Quartz Medicare Advantage |
$9.38
|
| Rate for Payer: The Alliance Commercial |
$37.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.38
|
| Rate for Payer: United Healthcare PPO |
$586.56
|
| Rate for Payer: WEA Trust Commercial |
$430.14
|
| Rate for Payer: Wellcare Medicare |
$9.38
|
| Rate for Payer: WPS Commercial |
$579.27
|
|
|
T4 Free, Direct Dialysis
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
983417
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$383.22 |
| Max. Negotiated Rate |
$719.51 |
| Rate for Payer: Aetna Commercial |
$703.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.50
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$719.51
|
| Rate for Payer: Health EOS Commercial |
$696.05
|
| Rate for Payer: HFN Commercial |
$719.51
|
| Rate for Payer: Multiplan Commercial |
$625.66
|
| Rate for Payer: Preferred Network Access Commercial |
$719.51
|
| Rate for Payer: Quartz Beloit One Network |
$383.22
|
| Rate for Payer: Quartz Commercial |
$469.25
|
| Rate for Payer: WEA Trust Commercial |
$430.14
|
| Rate for Payer: WPS Commercial |
$579.27
|
|
|
T4 Free, Direct Dialysis
|
Professional
|
Both
|
$752.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
983417
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$742.98 |
| Rate for Payer: Aetna Commercial |
$742.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.59
|
| Rate for Payer: Aetna Managed Medicare |
$9.38
|
| Rate for Payer: Anthem Medicare Advantage |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.38
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$742.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.38
|
| Rate for Payer: Health EOS Commercial |
$711.69
|
| Rate for Payer: HFN Commercial |
$742.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$625.66
|
| Rate for Payer: NAPHCARE Commercial |
$14.07
|
| Rate for Payer: Preferred Network Access Commercial |
$742.98
|
| Rate for Payer: Quartz Beloit One Network |
$344.12
|
| Rate for Payer: Quartz Commercial |
$445.79
|
| Rate for Payer: Quartz Medicare Advantage |
$9.38
|
| Rate for Payer: The Alliance Commercial |
$37.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.38
|
| Rate for Payer: WEA Trust Commercial |
$430.14
|
| Rate for Payer: WPS Commercial |
$41.28
|
|
|
TACKER ABSORBATACK 5MM ABSORBABLE FIXATION DEVICE ABSTACK30X
|
Facility
|
OP
|
$6,187.00
|
|
| Hospital Charge Code |
3825401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,801.65 |
| Max. Negotiated Rate |
$5,919.72 |
| Rate for Payer: Aetna Commercial |
$5,791.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,533.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,801.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,182.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,217.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,088.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,410.27
|
| Rate for Payer: Cash Price |
$1,856.10
|
| Rate for Payer: Cigna Commercial |
$5,919.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,600.83
|
| Rate for Payer: Health EOS Commercial |
$5,726.69
|
| Rate for Payer: HFN Commercial |
$5,919.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,825.86
|
| Rate for Payer: Multiplan Commercial |
$5,147.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,860.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,919.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,152.90
|
| Rate for Payer: Quartz Commercial |
$4,182.41
|
| Rate for Payer: Quartz Medicare Advantage |
$3,860.69
|
| Rate for Payer: The Alliance Commercial |
$3,217.24
|
| Rate for Payer: WEA Trust Commercial |
$3,538.96
|
| Rate for Payer: WPS Commercial |
$4,765.85
|
|
|
TACKER ABSORBATACK 5MM ABSORBABLE FIXATION DEVICE ABSTACK30X
|
Facility
|
IP
|
$6,187.00
|
|
| Hospital Charge Code |
3825401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,152.90 |
| Max. Negotiated Rate |
$5,919.72 |
| Rate for Payer: Aetna Commercial |
$5,791.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,533.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,410.27
|
| Rate for Payer: Cash Price |
$1,856.10
|
| Rate for Payer: Cigna Commercial |
$5,919.72
|
| Rate for Payer: Health EOS Commercial |
$5,726.69
|
| Rate for Payer: HFN Commercial |
$5,919.72
|
| Rate for Payer: Multiplan Commercial |
$5,147.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,919.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,152.90
|
| Rate for Payer: Quartz Commercial |
$3,860.69
|
| Rate for Payer: WEA Trust Commercial |
$3,538.96
|
| Rate for Payer: WPS Commercial |
$4,765.85
|
|
|
TACKER OPTIFIX AT ABSORBABLE ARTICULATING 15 0113315
|
Facility
|
IP
|
$3,766.00
|
|
| Hospital Charge Code |
5563427
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,919.15 |
| Max. Negotiated Rate |
$3,603.31 |
| Rate for Payer: Aetna Commercial |
$3,524.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,075.82
|
| Rate for Payer: Cash Price |
$1,129.80
|
| Rate for Payer: Cigna Commercial |
$3,603.31
|
| Rate for Payer: Health EOS Commercial |
$3,485.81
|
| Rate for Payer: HFN Commercial |
$3,603.31
|
| Rate for Payer: Multiplan Commercial |
$3,133.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,603.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.15
|
| Rate for Payer: Quartz Commercial |
$2,349.98
|
| Rate for Payer: WEA Trust Commercial |
$2,154.15
|
| Rate for Payer: WPS Commercial |
$2,900.95
|
|
|
TACKER OPTIFIX AT ABSORBABLE ARTICULATING 15 0113315
|
Facility
|
OP
|
$3,766.00
|
|
| Hospital Charge Code |
5563427
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,096.66 |
| Max. Negotiated Rate |
$3,603.31 |
| Rate for Payer: Aetna Commercial |
$3,524.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.31
|
| Rate for Payer: Aetna Managed Medicare |
$1,096.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,545.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,958.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,879.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,075.82
|
| Rate for Payer: Cash Price |
$1,129.80
|
| Rate for Payer: Cigna Commercial |
$3,603.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,191.81
|
| Rate for Payer: Health EOS Commercial |
$3,485.81
|
| Rate for Payer: HFN Commercial |
$3,603.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,937.48
|
| Rate for Payer: Multiplan Commercial |
$3,133.31
|
| Rate for Payer: NAPHCARE Commercial |
$2,349.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,603.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.15
|
| Rate for Payer: Quartz Commercial |
$2,545.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,349.98
|
| Rate for Payer: The Alliance Commercial |
$1,958.32
|
| Rate for Payer: WEA Trust Commercial |
$2,154.15
|
| Rate for Payer: WPS Commercial |
$2,900.95
|
|
|
TACKER OPTIFIX AT ABSORBABLE ARTICULATING 30 0113330
|
Facility
|
OP
|
$4,308.00
|
|
| Hospital Charge Code |
5497124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,254.49 |
| Max. Negotiated Rate |
$4,121.89 |
| Rate for Payer: Aetna Commercial |
$4,032.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,254.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,912.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,240.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,150.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,374.57
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,121.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,507.26
|
| Rate for Payer: Health EOS Commercial |
$3,987.48
|
| Rate for Payer: HFN Commercial |
$4,121.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.24
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,688.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,121.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.36
|
| Rate for Payer: Quartz Commercial |
$2,912.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,688.19
|
| Rate for Payer: The Alliance Commercial |
$2,240.16
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$3,318.45
|
|
|
TACKER OPTIFIX AT ABSORBABLE ARTICULATING 30 0113330
|
Facility
|
IP
|
$4,308.00
|
|
| Hospital Charge Code |
5497124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,195.36 |
| Max. Negotiated Rate |
$4,121.89 |
| Rate for Payer: Aetna Commercial |
$4,032.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,374.57
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,121.89
|
| Rate for Payer: Health EOS Commercial |
$3,987.48
|
| Rate for Payer: HFN Commercial |
$4,121.89
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,121.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.36
|
| Rate for Payer: Quartz Commercial |
$2,688.19
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$3,318.45
|
|
