|
Triiodothyronine
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
633833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.48
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$58.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: United Healthcare PPO |
$181.74
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: Wellcare Medicare |
$14.75
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
Triiodothyronine
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
633833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$230.20 |
| Rate for Payer: Aetna Commercial |
$230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$230.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$220.51
|
| Rate for Payer: HFN Commercial |
$230.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$230.20
|
| Rate for Payer: Quartz Beloit One Network |
$106.62
|
| Rate for Payer: Quartz Commercial |
$138.12
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$58.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$64.89
|
|
|
Triiodothyronine
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
633833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
Trimming of dystrophic nails, any number G0127
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
5468727
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$26.99 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$18.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$11.68
|
|
|
Trimming of Nondystrophic Nails 11719
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
2572826
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$94.85 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$90.85
|
| Rate for Payer: HFN Commercial |
$94.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$94.85
|
| Rate for Payer: Quartz Beloit One Network |
$43.93
|
| Rate for Payer: Quartz Commercial |
$56.91
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$28.38
|
| Rate for Payer: United Healthcare Medicaid |
$17.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$30.05
|
|
|
Trim Nails and Skin Debridement 1171909
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5468780
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$28.38
|
| Rate for Payer: United Healthcare Medicaid |
$17.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$30.05
|
|
|
Trim Nails Only 1171907
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
3147474
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$15.14
|
| Rate for Payer: HFN Commercial |
$15.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$7.32
|
| Rate for Payer: Quartz Commercial |
$9.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$28.38
|
| Rate for Payer: United Healthcare Medicaid |
$17.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$30.05
|
|
|
TROCAR 11.5MM THORACOPORT 179303
|
Facility
|
OP
|
$479.00
|
|
| Hospital Charge Code |
2963613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.62
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$298.90
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$298.90
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
TROCAR 11.5MM THORACOPORT 179303
|
Facility
|
IP
|
$479.00
|
|
| Hospital Charge Code |
2963613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
TROCAR 15MM x100MM SEPARATOR COR37
|
Facility
|
IP
|
$1,244.00
|
|
| Hospital Charge Code |
2962960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.94 |
| Max. Negotiated Rate |
$1,190.26 |
| Rate for Payer: Aetna Commercial |
$1,164.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.69
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,190.26
|
| Rate for Payer: Health EOS Commercial |
$1,151.45
|
| Rate for Payer: HFN Commercial |
$1,190.26
|
| Rate for Payer: Multiplan Commercial |
$1,035.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.26
|
| Rate for Payer: Quartz Beloit One Network |
$633.94
|
| Rate for Payer: Quartz Commercial |
$776.26
|
| Rate for Payer: WEA Trust Commercial |
$711.57
|
| Rate for Payer: WPS Commercial |
$958.25
|
|
|
TROCAR 15MM x100MM SEPARATOR COR37
|
Facility
|
OP
|
$1,244.00
|
|
| Hospital Charge Code |
2962960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$1,190.26 |
| Rate for Payer: Aetna Commercial |
$1,164.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.63
|
| Rate for Payer: Aetna Managed Medicare |
$362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$840.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.69
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,190.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.01
|
| Rate for Payer: Health EOS Commercial |
$1,151.45
|
| Rate for Payer: HFN Commercial |
$1,190.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$1,035.01
|
| Rate for Payer: NAPHCARE Commercial |
$776.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.26
|
| Rate for Payer: Quartz Beloit One Network |
$633.94
|
| Rate for Payer: Quartz Commercial |
$840.94
|
| Rate for Payer: Quartz Medicare Advantage |
$776.26
|
| Rate for Payer: The Alliance Commercial |
$646.88
|
| Rate for Payer: WEA Trust Commercial |
$711.57
|
| Rate for Payer: WPS Commercial |
$958.25
|
|
|
TROCAR 3.2MM 71751136
|
Facility
|
IP
|
$1,823.00
|
|
| Hospital Charge Code |
2966056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$1,744.25 |
| Rate for Payer: Aetna Commercial |
$1,706.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,630.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.84
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,744.25
|
| Rate for Payer: Health EOS Commercial |
$1,687.37
|
| Rate for Payer: HFN Commercial |
$1,744.25
|
| Rate for Payer: Multiplan Commercial |
$1,516.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.25
|
| Rate for Payer: Quartz Beloit One Network |
$929.00
|
| Rate for Payer: Quartz Commercial |
$1,137.55
|
| Rate for Payer: WEA Trust Commercial |
$1,042.76
|
| Rate for Payer: WPS Commercial |
$1,404.26
|
|
|
TROCAR 3.2MM 71751136
|
Facility
|
OP
|
$1,823.00
|
|
| Hospital Charge Code |
2966056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.86 |
| Max. Negotiated Rate |
$1,744.25 |
| Rate for Payer: Aetna Commercial |
$1,706.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,630.49
|
| Rate for Payer: Aetna Managed Medicare |
$530.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,232.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.84
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,744.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.99
|
| Rate for Payer: Health EOS Commercial |
$1,687.37
|
| Rate for Payer: HFN Commercial |
$1,744.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.94
|
| Rate for Payer: Multiplan Commercial |
$1,516.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.25
|
| Rate for Payer: Quartz Beloit One Network |
$929.00
|
| Rate for Payer: Quartz Commercial |
$1,232.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,137.55
|
| Rate for Payer: The Alliance Commercial |
$947.96
|
| Rate for Payer: WEA Trust Commercial |
$1,042.76
|
| Rate for Payer: WPS Commercial |
$1,404.26
|
|
|
TROCAR 5MM APPLE #900-800
|
Facility
|
IP
|
$672.00
|
|
| Hospital Charge Code |
2963108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$342.45 |
| Max. Negotiated Rate |
$642.97 |
| Rate for Payer: Aetna Commercial |
$628.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.41
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Health EOS Commercial |
$622.00
|
| Rate for Payer: HFN Commercial |
$642.97
|
| Rate for Payer: Multiplan Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$642.97
|
| Rate for Payer: Quartz Beloit One Network |
$342.45
|
| Rate for Payer: Quartz Commercial |
$419.33
|
| Rate for Payer: WEA Trust Commercial |
$384.38
|
| Rate for Payer: WPS Commercial |
$517.64
|
|
|
TROCAR 5MM APPLE #900-800
|
Facility
|
OP
|
$672.00
|
|
| Hospital Charge Code |
2963108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.69 |
| Max. Negotiated Rate |
$642.97 |
| Rate for Payer: Aetna Commercial |
$628.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.04
|
| Rate for Payer: Aetna Managed Medicare |
$195.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$454.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$349.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$335.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.41
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.10
|
| Rate for Payer: Health EOS Commercial |
$622.00
|
| Rate for Payer: HFN Commercial |
$642.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.16
|
| Rate for Payer: Multiplan Commercial |
$559.10
|
| Rate for Payer: NAPHCARE Commercial |
$419.33
|
| Rate for Payer: Preferred Network Access Commercial |
$642.97
|
| Rate for Payer: Quartz Beloit One Network |
$342.45
|
| Rate for Payer: Quartz Commercial |
$454.27
|
| Rate for Payer: Quartz Medicare Advantage |
$419.33
|
| Rate for Payer: The Alliance Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$384.38
|
| Rate for Payer: WPS Commercial |
$517.64
|
|
|
TROCAR 5 X 150MM
|
Facility
|
OP
|
$414.00
|
|
| Hospital Charge Code |
3153467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.92
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$258.34
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$258.34
|
| Rate for Payer: The Alliance Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
TROCAR 5 X 150MM
|
Facility
|
IP
|
$414.00
|
|
| Hospital Charge Code |
3153467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
TROCAR 8X100MM WITH STABILITY SLEEVE B8LT
|
Facility
|
IP
|
$2,284.00
|
|
| Hospital Charge Code |
4520302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,163.93 |
| Max. Negotiated Rate |
$2,185.33 |
| Rate for Payer: Aetna Commercial |
$2,137.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,042.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,258.94
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cigna Commercial |
$2,185.33
|
| Rate for Payer: Health EOS Commercial |
$2,114.07
|
| Rate for Payer: HFN Commercial |
$2,185.33
|
| Rate for Payer: Multiplan Commercial |
$1,900.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,185.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,163.93
|
| Rate for Payer: Quartz Commercial |
$1,425.22
|
| Rate for Payer: WEA Trust Commercial |
$1,306.45
|
| Rate for Payer: WPS Commercial |
$1,759.37
|
|
|
TROCAR 8X100MM WITH STABILITY SLEEVE B8LT
|
Facility
|
OP
|
$2,284.00
|
|
| Hospital Charge Code |
4520302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.10 |
| Max. Negotiated Rate |
$2,185.33 |
| Rate for Payer: Aetna Commercial |
$2,137.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,042.81
|
| Rate for Payer: Aetna Managed Medicare |
$665.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,543.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,187.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,140.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,258.94
|
| Rate for Payer: Cash Price |
$685.20
|
| Rate for Payer: Cigna Commercial |
$2,185.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,329.29
|
| Rate for Payer: Health EOS Commercial |
$2,114.07
|
| Rate for Payer: HFN Commercial |
$2,185.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,781.52
|
| Rate for Payer: Multiplan Commercial |
$1,900.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,425.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,185.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,163.93
|
| Rate for Payer: Quartz Commercial |
$1,543.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,425.22
|
| Rate for Payer: The Alliance Commercial |
$1,187.68
|
| Rate for Payer: WEA Trust Commercial |
$1,306.45
|
| Rate for Payer: WPS Commercial |
$1,759.37
|
|
|
TROCAR BALLOON BLUNT TIP 12 X 130MM C0R50
|
Facility
|
IP
|
$556.00
|
|
| Hospital Charge Code |
2975050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
TROCAR BALLOON BLUNT TIP 12 X 130MM C0R50
|
Facility
|
OP
|
$556.00
|
|
| Hospital Charge Code |
2975050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
TROCAR BLADED 12X150MM CFB71
|
Facility
|
IP
|
$1,097.00
|
|
| Hospital Charge Code |
2963090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.03 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$684.53
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
TROCAR BLADED 12X150MM CFB71
|
Facility
|
OP
|
$1,097.00
|
|
| Hospital Charge Code |
2963090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.45 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Aetna Managed Medicare |
$319.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$741.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$570.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$638.45
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.66
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: NAPHCARE Commercial |
$684.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$741.57
|
| Rate for Payer: Quartz Medicare Advantage |
$684.53
|
| Rate for Payer: The Alliance Commercial |
$570.44
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
TROCAR BLADED 5X100MM CFB03
|
Facility
|
OP
|
$456.00
|
|
| Hospital Charge Code |
3092814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Aetna Managed Medicare |
$132.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.39
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.68
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: NAPHCARE Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: Quartz Medicare Advantage |
$284.54
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
TROCAR BLADED 5X100MM CFB03
|
Facility
|
IP
|
$456.00
|
|
| Hospital Charge Code |
3092814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
