|
CARPAL TUNNEL RELEASE, ENDOSCOPIC
|
Facility
|
IP
|
$6,866.00
|
|
| Hospital Charge Code |
2960008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,498.91 |
| Max. Negotiated Rate |
$6,569.39 |
| Rate for Payer: Aetna Commercial |
$6,426.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,140.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,784.54
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,569.39
|
| Rate for Payer: Health EOS Commercial |
$6,355.17
|
| Rate for Payer: HFN Commercial |
$6,569.39
|
| Rate for Payer: Multiplan Commercial |
$5,712.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,569.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,498.91
|
| Rate for Payer: Quartz Commercial |
$4,284.38
|
| Rate for Payer: WEA Trust Commercial |
$3,927.35
|
| Rate for Payer: WPS Commercial |
$5,288.88
|
|
|
CARPAL TUNNEL SURGERY 64721
|
Professional
|
Both
|
$2,989.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
3015206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$362.71 |
| Max. Negotiated Rate |
$2,953.13 |
| Rate for Payer: Aetna Commercial |
$2,953.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,673.36
|
| Rate for Payer: Aetna Managed Medicare |
$406.36
|
| Rate for Payer: Anthem Medicare Advantage |
$406.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$406.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$406.36
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,953.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$362.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.36
|
| Rate for Payer: Health EOS Commercial |
$2,828.79
|
| Rate for Payer: HFN Commercial |
$2,953.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,505.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,505.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$406.36
|
| Rate for Payer: Multiplan Commercial |
$2,486.85
|
| Rate for Payer: NAPHCARE Commercial |
$609.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,953.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,771.88
|
| Rate for Payer: Quartz Medicare Advantage |
$406.36
|
| Rate for Payer: The Alliance Commercial |
$1,727.03
|
| Rate for Payer: United Healthcare Medicaid |
$362.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$406.36
|
| Rate for Payer: WEA Trust Commercial |
$1,709.71
|
| Rate for Payer: WPS Commercial |
$1,828.62
|
|
|
CARPECTOMY; ALL BONES OF PROXIMAL ROW
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
Car Seat Challenge Testing (30 min) - Nursery Daily Charges
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
5699636
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Car Seat Challenge Testing (30 min) - Nursery Daily Charges
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
5699636
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$28.04 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$30.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$65.52
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$65.52
|
| Rate for Payer: The Alliance Commercial |
$28.04
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Car Seat Challenge Testing (60 min) - Nursery Daily Charges
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
5699637
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
Car Seat Challenge Testing (60 min) - Nursery Daily Charges
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
5699637
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
CARTILAGE BUR 3MM X 12MM PROSTEP MIS STERILE 58CC3012
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6200964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.33 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,094.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,540.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,954.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,875.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,187.16
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,931.24
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,344.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,540.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,344.99
|
| Rate for Payer: The Alliance Commercial |
$1,954.16
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
CARTILAGE BUR 3MM X 12MM PROSTEP MIS STERILE 58CC3012
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6200964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,915.08 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,344.99
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
CARTILAGE BUR 4MM X 16MM PROSTEP MIS STERILE 58CC4016
|
Facility
|
IP
|
$5,414.00
|
|
| Hospital Charge Code |
6172007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,758.97 |
| Max. Negotiated Rate |
$5,180.12 |
| Rate for Payer: Aetna Commercial |
$5,067.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,842.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,984.20
|
| Rate for Payer: Cash Price |
$1,624.20
|
| Rate for Payer: Cigna Commercial |
$5,180.12
|
| Rate for Payer: Health EOS Commercial |
$5,011.20
|
| Rate for Payer: HFN Commercial |
$5,180.12
|
| Rate for Payer: Multiplan Commercial |
$4,504.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,180.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,758.97
|
| Rate for Payer: Quartz Commercial |
$3,378.34
|
| Rate for Payer: WEA Trust Commercial |
$3,096.81
|
| Rate for Payer: WPS Commercial |
$4,170.40
|
|
|
CARTILAGE BUR 4MM X 16MM PROSTEP MIS STERILE 58CC4016
|
Facility
|
OP
|
$5,414.00
|
|
| Hospital Charge Code |
6172007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,576.56 |
| Max. Negotiated Rate |
$5,180.12 |
| Rate for Payer: Aetna Commercial |
$5,067.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,842.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,576.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,659.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,815.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,702.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,984.20
|
| Rate for Payer: Cash Price |
$1,624.20
|
| Rate for Payer: Cigna Commercial |
$5,180.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,150.95
|
| Rate for Payer: Health EOS Commercial |
$5,011.20
|
| Rate for Payer: HFN Commercial |
$5,180.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,222.92
|
| Rate for Payer: Multiplan Commercial |
$4,504.45
|
| Rate for Payer: NAPHCARE Commercial |
$3,378.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,180.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,758.97
|
| Rate for Payer: Quartz Commercial |
$3,659.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,378.34
|
| Rate for Payer: The Alliance Commercial |
$2,815.28
|
| Rate for Payer: WEA Trust Commercial |
$3,096.81
|
| Rate for Payer: WPS Commercial |
$4,170.40
|
|
|
CARTILAGE GRAFT; NASAL SEPTUM
|
Facility
|
OP
|
$14,917.51
|
|
|
Service Code
|
CPT 20912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,729.38 |
| Max. Negotiated Rate |
$14,917.51 |
| Rate for Payer: Aetna Managed Medicare |
$3,729.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,729.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,729.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,729.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,729.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,729.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,873.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,729.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,729.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,729.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,729.38
|
| Rate for Payer: NAPHCARE Commercial |
$5,594.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,729.38
|
| Rate for Payer: The Alliance Commercial |
$14,917.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,729.38
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,729.38
|
|
|
CARTRIDGE BLOOD LINE CS3 #1010256035461
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2971907
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CARTRIDGE BLOOD LINE CS3 #1010256035461
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2971907
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CARTRIDGE B MONARCH III
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2964183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
CARTRIDGE B MONARCH III
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
2964183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
CARTRIDGE LIGACLIP BLUE SMALL 6 CLIPS LT100
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2965762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP BLUE SMALL 6 CLIPS LT100
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2965762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP GREEN MED/LG 6 CLIPS LT300
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2965764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP GREEN MED/LG 6 CLIPS LT300
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2965764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP SILVER MEDIUM 20 CLIPS LT202
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2965763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP SILVER MEDIUM 20 CLIPS LT202
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2965763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP YELLOW LARGE 6 CLIPS LT400
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2965765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
CARTRIDGE LIGACLIP YELLOW LARGE 6 CLIPS LT400
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2965765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
Cartridges-V-Vac Suction Rplmt
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
3040350
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
