|
Coude - Urinary Catheter Type
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
2999941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
Coude - Urinary Catheter Type
|
Facility
OP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
2999941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$330.85
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
Coude* - Urinary Catheter Type:
|
Facility
OP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510856
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$330.85
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
Coude* - Urinary Catheter Type:
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510856
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
Counseling Care Urine Drug Screen
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
4605712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Counseling Care Urine Drug Screen
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
4605712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$17.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.45
|
| Rate for Payer: Anthem Medicaid |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.14
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.71
|
| Rate for Payer: Dean Health Medicaid |
$17.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.14
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.14
|
| Rate for Payer: Managed Health Services Medicaid |
$18.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.71
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.71
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$17.14
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.14
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$17.14
|
| Rate for Payer: WMAP Medicaid |
$17.71
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Counseling Care Urine Drug Screen
|
Professional
|
$55.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
4605712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$17.14
|
| Rate for Payer: Anthem Medicare Advantage |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.14
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.14
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: Quartz Medicare Advantage |
$17.14
|
| Rate for Payer: The Alliance Commercial |
$67.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.14
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$75.42
|
|
|
COUNTERSINK 4.0MM CANN DART-FIRE COMPRESSION SCREW DSDS1040
|
Facility
OP
|
$3,178.00
|
|
| Hospital Charge Code |
6182385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$889.84 |
| Max. Negotiated Rate |
$12,712.00 |
| Rate for Payer: Aetna Commercial |
$2,860.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,733.08
|
| Rate for Payer: Aetna Managed Medicare |
$889.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,065.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,589.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,525.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,684.34
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$2,923.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,778.41
|
| Rate for Payer: Health EOS Commercial |
$2,828.42
|
| Rate for Payer: HFN Commercial |
$2,923.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,383.50
|
| Rate for Payer: Multiplan Commercial |
$2,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,906.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,923.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,557.22
|
| Rate for Payer: Quartz Commercial |
$2,065.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,906.80
|
| Rate for Payer: The Alliance Commercial |
$12,712.00
|
| Rate for Payer: WEA Trust Commercial |
$1,747.90
|
| Rate for Payer: WPS Commercial |
$2,353.94
|
|
|
COUNTERSINK 4.0MM CANN DART-FIRE COMPRESSION SCREW DSDS1040
|
Facility
IP
|
$3,178.00
|
|
| Hospital Charge Code |
6182385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,557.22 |
| Max. Negotiated Rate |
$2,923.76 |
| Rate for Payer: Aetna Commercial |
$2,860.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,684.34
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$2,923.76
|
| Rate for Payer: Health EOS Commercial |
$2,828.42
|
| Rate for Payer: HFN Commercial |
$2,923.76
|
| Rate for Payer: Multiplan Commercial |
$2,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,906.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,923.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,557.22
|
| Rate for Payer: Quartz Commercial |
$1,906.80
|
| Rate for Payer: WEA Trust Commercial |
$1,747.90
|
| Rate for Payer: WPS Commercial |
$2,353.94
|
|
|
COUNTERSINK 5.0 CANNULATE DSDS1050
|
Facility
OP
|
$1,983.00
|
|
| Hospital Charge Code |
5547330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.24 |
| Max. Negotiated Rate |
$7,932.00 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.38
|
| Rate for Payer: Aetna Managed Medicare |
$555.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,288.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.99
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,824.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.69
|
| Rate for Payer: Health EOS Commercial |
$1,764.87
|
| Rate for Payer: HFN Commercial |
$1,824.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.25
|
| Rate for Payer: Multiplan Commercial |
$1,586.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.36
|
| Rate for Payer: Quartz Beloit One Network |
$971.67
|
| Rate for Payer: Quartz Commercial |
$1,288.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.80
|
| Rate for Payer: The Alliance Commercial |
$7,932.00
|
| Rate for Payer: WEA Trust Commercial |
$1,090.65
|
| Rate for Payer: WPS Commercial |
$1,468.81
|
|
|
COUNTERSINK 5.0 CANNULATE DSDS1050
|
Facility
IP
|
$1,983.00
|
|
| Hospital Charge Code |
5547330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.67 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.99
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,824.36
|
| Rate for Payer: Health EOS Commercial |
$1,764.87
|
| Rate for Payer: HFN Commercial |
$1,824.36
|
| Rate for Payer: Multiplan Commercial |
$1,586.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.36
|
| Rate for Payer: Quartz Beloit One Network |
$971.67
|
| Rate for Payer: Quartz Commercial |
$1,189.80
|
| Rate for Payer: WEA Trust Commercial |
$1,090.65
|
| Rate for Payer: WPS Commercial |
$1,468.81
|
|
|
COUNTERSINK 6.0 CANNULATE DSDS1060
|
Facility
IP
|
$2,012.00
|
|
| Hospital Charge Code |
6173854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$985.88 |
| Max. Negotiated Rate |
$1,851.04 |
| Rate for Payer: Aetna Commercial |
$1,810.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,066.36
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,851.04
|
| Rate for Payer: Health EOS Commercial |
$1,790.68
|
| Rate for Payer: HFN Commercial |
$1,851.04
|
| Rate for Payer: Multiplan Commercial |
$1,609.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,207.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,851.04
|
| Rate for Payer: Quartz Beloit One Network |
$985.88
|
| Rate for Payer: Quartz Commercial |
$1,207.20
|
| Rate for Payer: WEA Trust Commercial |
$1,106.60
|
| Rate for Payer: WPS Commercial |
$1,490.29
|
|
|
COUNTERSINK 6.0 CANNULATE DSDS1060
|
Facility
OP
|
$2,012.00
|
|
| Hospital Charge Code |
6173854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.36 |
| Max. Negotiated Rate |
$8,048.00 |
| Rate for Payer: Aetna Commercial |
$1,810.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,730.32
|
| Rate for Payer: Aetna Managed Medicare |
$563.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,307.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,006.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$965.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,066.36
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,851.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,125.92
|
| Rate for Payer: Health EOS Commercial |
$1,790.68
|
| Rate for Payer: HFN Commercial |
$1,851.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,509.00
|
| Rate for Payer: Multiplan Commercial |
$1,609.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,207.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,851.04
|
| Rate for Payer: Quartz Beloit One Network |
$985.88
|
| Rate for Payer: Quartz Commercial |
$1,307.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,207.20
|
| Rate for Payer: The Alliance Commercial |
$8,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,106.60
|
| Rate for Payer: WPS Commercial |
$1,490.29
|
|
|
COUNTERSINK ASNIS III CANN 6.5/8.0 AO FITTING 702621
|
Facility
OP
|
$1,692.00
|
|
| Hospital Charge Code |
6201057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.76 |
| Max. Negotiated Rate |
$6,768.00 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$473.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,015.20
|
| Rate for Payer: The Alliance Commercial |
$6,768.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
COUNTERSINK ASNIS III CANN 6.5/8.0 AO FITTING 702621
|
Facility
IP
|
$1,692.00
|
|
| Hospital Charge Code |
6201057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
COUNTERSINK CANN 2.0/2.4 TIGER 210-24-002
|
Facility
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3133495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
COUNTERSINK CANN 2.0/2.4 TIGER 210-24-002
|
Facility
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3133495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$12,664.00 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Aetna Managed Medicare |
$886.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,771.69
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,374.50
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$2,057.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,899.60
|
| Rate for Payer: The Alliance Commercial |
$12,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
COUNTERSINK CANN 2.8MM AO 45-20007S
|
Facility
IP
|
$2,080.00
|
|
| Hospital Charge Code |
6171705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,019.20 |
| Max. Negotiated Rate |
$1,913.60 |
| Rate for Payer: Aetna Commercial |
$1,872.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,102.40
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$1,913.60
|
| Rate for Payer: Health EOS Commercial |
$1,851.20
|
| Rate for Payer: HFN Commercial |
$1,913.60
|
| Rate for Payer: Multiplan Commercial |
$1,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,913.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.20
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| Rate for Payer: WEA Trust Commercial |
$1,144.00
|
| Rate for Payer: WPS Commercial |
$1,540.66
|
|
|
COUNTERSINK CANN 2.8MM AO 45-20007S
|
Facility
OP
|
$2,080.00
|
|
| Hospital Charge Code |
6171705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.40 |
| Max. Negotiated Rate |
$8,320.00 |
| Rate for Payer: Aetna Commercial |
$1,872.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,788.80
|
| Rate for Payer: Aetna Managed Medicare |
$582.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,352.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$998.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,102.40
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$1,913.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,163.97
|
| Rate for Payer: Health EOS Commercial |
$1,851.20
|
| Rate for Payer: HFN Commercial |
$1,913.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,560.00
|
| Rate for Payer: Multiplan Commercial |
$1,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,913.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.20
|
| Rate for Payer: Quartz Commercial |
$1,352.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,248.00
|
| Rate for Payer: The Alliance Commercial |
$8,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,144.00
|
| Rate for Payer: WPS Commercial |
$1,540.66
|
|
|
COUNTERSINK CANN 3.0/4.0 TIGER 210-40-002
|
Facility
OP
|
$3,048.00
|
|
| Hospital Charge Code |
3323484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$853.44 |
| Max. Negotiated Rate |
$12,192.00 |
| Rate for Payer: Quartz Beloit One Network |
$1,493.52
|
| Rate for Payer: Aetna Commercial |
$2,743.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.28
|
| Rate for Payer: Aetna Managed Medicare |
$853.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,981.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,524.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,463.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.44
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,804.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,705.66
|
| Rate for Payer: Health EOS Commercial |
$2,712.72
|
| Rate for Payer: HFN Commercial |
$2,804.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,286.00
|
| Rate for Payer: Multiplan Commercial |
$2,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.16
|
| Rate for Payer: Quartz Commercial |
$1,981.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,828.80
|
| Rate for Payer: The Alliance Commercial |
$12,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,676.40
|
| Rate for Payer: WPS Commercial |
$2,257.65
|
|
|
COUNTERSINK CANN 3.0/4.0 TIGER 210-40-002
|
Facility
IP
|
$3,048.00
|
|
| Hospital Charge Code |
3323484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,493.52 |
| Max. Negotiated Rate |
$2,804.16 |
| Rate for Payer: Aetna Commercial |
$2,743.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.44
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,804.16
|
| Rate for Payer: Health EOS Commercial |
$2,712.72
|
| Rate for Payer: HFN Commercial |
$2,804.16
|
| Rate for Payer: Multiplan Commercial |
$2,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.52
|
| Rate for Payer: Quartz Commercial |
$1,828.80
|
| Rate for Payer: WEA Trust Commercial |
$1,676.40
|
| Rate for Payer: WPS Commercial |
$2,257.65
|
|
|
COUNTERSINK CANN 3.8MM AO 45-30007S
|
Facility
OP
|
$1,932.00
|
|
| Hospital Charge Code |
6171707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.96 |
| Max. Negotiated Rate |
$7,728.00 |
| Rate for Payer: Aetna Commercial |
$1,738.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,661.52
|
| Rate for Payer: Aetna Managed Medicare |
$540.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,255.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$966.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$927.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.96
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,777.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,081.15
|
| Rate for Payer: Health EOS Commercial |
$1,719.48
|
| Rate for Payer: HFN Commercial |
$1,777.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,545.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,777.44
|
| Rate for Payer: Quartz Beloit One Network |
$946.68
|
| Rate for Payer: Quartz Commercial |
$1,255.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,159.20
|
| Rate for Payer: The Alliance Commercial |
$7,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,062.60
|
| Rate for Payer: WPS Commercial |
$1,431.03
|
|
|
COUNTERSINK CANN 3.8MM AO 45-30007S
|
Facility
IP
|
$1,932.00
|
|
| Hospital Charge Code |
6171707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$946.68 |
| Max. Negotiated Rate |
$1,777.44 |
| Rate for Payer: Aetna Commercial |
$1,738.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.96
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,777.44
|
| Rate for Payer: Health EOS Commercial |
$1,719.48
|
| Rate for Payer: HFN Commercial |
$1,777.44
|
| Rate for Payer: Multiplan Commercial |
$1,545.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,777.44
|
| Rate for Payer: Quartz Beloit One Network |
$946.68
|
| Rate for Payer: Quartz Commercial |
$1,159.20
|
| Rate for Payer: WEA Trust Commercial |
$1,062.60
|
| Rate for Payer: WPS Commercial |
$1,431.03
|
|
|
COUNTERSINK CANN 4.0MM AO COUPLING STRYKER 702473
|
Facility
IP
|
$1,891.00
|
|
| Hospital Charge Code |
6185030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$926.59 |
| Max. Negotiated Rate |
$1,739.72 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.23
|
| Rate for Payer: Cash Price |
$567.30
|
| Rate for Payer: Cigna Commercial |
$1,739.72
|
| Rate for Payer: Health EOS Commercial |
$1,682.99
|
| Rate for Payer: HFN Commercial |
$1,739.72
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,134.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,739.72
|
| Rate for Payer: Quartz Beloit One Network |
$926.59
|
| Rate for Payer: Quartz Commercial |
$1,134.60
|
| Rate for Payer: WEA Trust Commercial |
$1,040.05
|
| Rate for Payer: WPS Commercial |
$1,400.66
|
|
|
COUNTERSINK CANN 4.0MM AO COUPLING STRYKER 702473
|
Facility
OP
|
$1,891.00
|
|
| Hospital Charge Code |
6185030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$529.48 |
| Max. Negotiated Rate |
$7,564.00 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.26
|
| Rate for Payer: Aetna Managed Medicare |
$529.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,229.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$945.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$907.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.23
|
| Rate for Payer: Cash Price |
$567.30
|
| Rate for Payer: Cigna Commercial |
$1,739.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,058.20
|
| Rate for Payer: Health EOS Commercial |
$1,682.99
|
| Rate for Payer: HFN Commercial |
$1,739.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,418.25
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,134.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,739.72
|
| Rate for Payer: Quartz Beloit One Network |
$926.59
|
| Rate for Payer: Quartz Commercial |
$1,229.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,134.60
|
| Rate for Payer: The Alliance Commercial |
$7,564.00
|
| Rate for Payer: WEA Trust Commercial |
$1,040.05
|
| Rate for Payer: WPS Commercial |
$1,400.66
|
|
