|
TOE CREST MED LEFT 6505-9
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
2970996
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
TOE CREST MED LEFT 6505-9
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
2970996
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
TOE CREST MED RT 6505-8
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
2970995
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
TOE CREST MED RT 6505-8
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
2970995
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Toe Filler L5000
|
Professional
|
$189.00
|
|
|
Service Code
|
HCPCS L5000
|
| Hospital Charge Code |
5605758
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$2,034.76 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.40
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,034.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,034.76
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: The Alliance Commercial |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Toe Filler L5000
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
HCPCS L5000
|
| Hospital Charge Code |
5605758
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Toe Filler L5000
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
HCPCS L5000
|
| Hospital Charge Code |
5605758
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
TOE OSTEOTOMY/ARTHRODESIS
|
Facility
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2960297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.36 |
| Max. Negotiated Rate |
$19,648.00 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,192.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.76
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,684.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$3,192.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,947.20
|
| Rate for Payer: The Alliance Commercial |
$19,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
TOE OSTEOTOMY/ARTHRODESIS
|
Facility
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2960297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,406.88 |
| Max. Negotiated Rate |
$4,519.04 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$2,947.20
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
TOE, TENDON & NERVE REPAIR
|
Facility
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$4,968.00 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$347.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$807.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$596.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$695.02
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.50
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$807.30
|
| Rate for Payer: Quartz Medicare Advantage |
$745.20
|
| Rate for Payer: The Alliance Commercial |
$4,968.00
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
TOE, TENDON & NERVE REPAIR
|
Facility
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$745.20
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
TOGA FLYTE X-LARGE 408-830
|
Facility
OP
|
$1,370.00
|
|
| Hospital Charge Code |
4089815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$5,480.00 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,178.20
|
| Rate for Payer: Aetna Managed Medicare |
$383.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$890.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$685.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$657.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.10
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,260.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$766.65
|
| Rate for Payer: Health EOS Commercial |
$1,219.30
|
| Rate for Payer: HFN Commercial |
$1,260.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,027.50
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$822.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.40
|
| Rate for Payer: Quartz Beloit One Network |
$671.30
|
| Rate for Payer: Quartz Commercial |
$890.50
|
| Rate for Payer: Quartz Medicare Advantage |
$822.00
|
| Rate for Payer: The Alliance Commercial |
$5,480.00
|
| Rate for Payer: WEA Trust Commercial |
$753.50
|
| Rate for Payer: WPS Commercial |
$1,014.76
|
|
|
TOGA FLYTE X-LARGE 408-830
|
Facility
IP
|
$1,370.00
|
|
| Hospital Charge Code |
4089815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$671.30 |
| Max. Negotiated Rate |
$1,260.40 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.10
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,260.40
|
| Rate for Payer: Health EOS Commercial |
$1,219.30
|
| Rate for Payer: HFN Commercial |
$1,260.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$822.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.40
|
| Rate for Payer: Quartz Beloit One Network |
$671.30
|
| Rate for Payer: Quartz Commercial |
$822.00
|
| Rate for Payer: WEA Trust Commercial |
$753.50
|
| Rate for Payer: WPS Commercial |
$1,014.76
|
|
|
TOGA FLYTE XXL 0408-840-000
|
Facility
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2966090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.33 |
| Max. Negotiated Rate |
$1,027.64 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$670.20
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
TOGA FLYTE XXL 0408-840-000
|
Facility
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2966090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.76 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Aetna Managed Medicare |
$312.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$558.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.07
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$837.75
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$726.05
|
| Rate for Payer: Quartz Medicare Advantage |
$670.20
|
| Rate for Payer: The Alliance Commercial |
$4,468.00
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
TOGA FLYTE XXL PEEL-AWAY 0408-840-100
|
Facility
IP
|
$1,811.00
|
|
| Hospital Charge Code |
4520105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.39 |
| Max. Negotiated Rate |
$1,666.12 |
| Rate for Payer: NAPHCARE Commercial |
$1,086.60
|
| Rate for Payer: Aetna Commercial |
$1,629.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.83
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,666.12
|
| Rate for Payer: Health EOS Commercial |
$1,611.79
|
| Rate for Payer: HFN Commercial |
$1,666.12
|
| Rate for Payer: Multiplan Commercial |
$1,448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.12
|
| Rate for Payer: Quartz Beloit One Network |
$887.39
|
| Rate for Payer: Quartz Commercial |
$1,086.60
|
| Rate for Payer: WEA Trust Commercial |
$996.05
|
| Rate for Payer: WPS Commercial |
$1,341.41
|
|
|
TOGA FLYTE XXL PEEL-AWAY 0408-840-100
|
Facility
OP
|
$1,811.00
|
|
| Hospital Charge Code |
4520105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.08 |
| Max. Negotiated Rate |
$7,244.00 |
| Rate for Payer: Aetna Commercial |
$1,629.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.46
|
| Rate for Payer: Aetna Managed Medicare |
$507.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$905.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.83
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,666.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,013.44
|
| Rate for Payer: Health EOS Commercial |
$1,611.79
|
| Rate for Payer: HFN Commercial |
$1,666.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.25
|
| Rate for Payer: Multiplan Commercial |
$1,448.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.12
|
| Rate for Payer: Quartz Beloit One Network |
$887.39
|
| Rate for Payer: Quartz Commercial |
$1,177.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,086.60
|
| Rate for Payer: The Alliance Commercial |
$7,244.00
|
| Rate for Payer: WEA Trust Commercial |
$996.05
|
| Rate for Payer: WPS Commercial |
$1,341.41
|
|
|
TOGA HOOD FLYTE REGULAR 0408-801-400
|
Facility
OP
|
$445.00
|
|
| Hospital Charge Code |
5591280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$1,780.00 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Aetna Managed Medicare |
$124.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$289.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.02
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.75
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$289.25
|
| Rate for Payer: Quartz Medicare Advantage |
$267.00
|
| Rate for Payer: The Alliance Commercial |
$1,780.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
TOGA HOOD FLYTE REGULAR 0408-801-400
|
Facility
IP
|
$445.00
|
|
| Hospital Charge Code |
5591280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
TOGA HOOD PEEL-AWAY FLYTE 0408-800-100
|
Facility
IP
|
$739.00
|
|
| Hospital Charge Code |
5591302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
TOGA HOOD PEEL-AWAY FLYTE 0408-800-100
|
Facility
OP
|
$739.00
|
|
| Hospital Charge Code |
5591302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
TOGA HOOD T7 PLUS ANTI-REFLECTIVE LENS 0416-801-200
|
Facility
IP
|
$499.00
|
|
| Hospital Charge Code |
6181770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
TOGA HOOD T7 PLUS ANTI-REFLECTIVE LENS 0416-801-200
|
Facility
OP
|
$499.00
|
|
| Hospital Charge Code |
6181770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
TOGA HOOD T7 PLUS PEEL-AWAY 0416-801-100
|
Facility
OP
|
$714.00
|
|
| Hospital Charge Code |
6181769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
TOGA HOOD T7 PLUS PEEL-AWAY 0416-801-100
|
Facility
IP
|
$714.00
|
|
| Hospital Charge Code |
6181769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
