|
COMPONENT FEM H-RT CR PRECOAT 5970-18-02
|
Facility
|
IP
|
$11,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,808.42 |
| Max. Negotiated Rate |
$10,905.61 |
| Rate for Payer: Aetna Commercial |
$10,668.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,194.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,282.58
|
| Rate for Payer: Cash Price |
$3,419.40
|
| Rate for Payer: Cigna Commercial |
$10,905.61
|
| Rate for Payer: Health EOS Commercial |
$10,549.99
|
| Rate for Payer: HFN Commercial |
$10,905.61
|
| Rate for Payer: Multiplan Commercial |
$9,483.14
|
| Rate for Payer: Preferred Network Access Commercial |
$10,905.61
|
| Rate for Payer: Quartz Beloit One Network |
$5,808.42
|
| Rate for Payer: Quartz Commercial |
$7,112.35
|
| Rate for Payer: WEA Trust Commercial |
$6,519.66
|
| Rate for Payer: WPS Commercial |
$8,779.88
|
|
|
COMPONENT FEM H-RT CR PRECOAT 5970-18-02
|
Facility
|
OP
|
$11,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,319.10 |
| Max. Negotiated Rate |
$10,905.61 |
| Rate for Payer: Aetna Commercial |
$10,668.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,194.37
|
| Rate for Payer: Aetna Managed Medicare |
$3,319.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,705.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,926.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,689.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,282.58
|
| Rate for Payer: Cash Price |
$3,419.40
|
| Rate for Payer: Cigna Commercial |
$10,905.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,633.64
|
| Rate for Payer: Health EOS Commercial |
$10,549.99
|
| Rate for Payer: HFN Commercial |
$10,905.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,890.44
|
| Rate for Payer: Multiplan Commercial |
$9,483.14
|
| Rate for Payer: NAPHCARE Commercial |
$7,112.35
|
| Rate for Payer: Preferred Network Access Commercial |
$10,905.61
|
| Rate for Payer: Quartz Beloit One Network |
$5,808.42
|
| Rate for Payer: Quartz Commercial |
$7,705.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,112.35
|
| Rate for Payer: The Alliance Commercial |
$5,926.96
|
| Rate for Payer: WEA Trust Commercial |
$6,519.66
|
| Rate for Payer: WPS Commercial |
$8,779.88
|
|
|
Comprehensive Audiology Eval
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
3203512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$275.56 |
| Rate for Payer: Aetna Commercial |
$269.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.75
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: Health EOS Commercial |
$266.57
|
| Rate for Payer: HFN Commercial |
$275.56
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: Preferred Network Access Commercial |
$275.56
|
| Rate for Payer: Quartz Beloit One Network |
$146.76
|
| Rate for Payer: Quartz Commercial |
$179.71
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$221.85
|
|
|
Comprehensive Audiology Eval
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
3203512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$269.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$194.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$149.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143.77
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$266.57
|
| Rate for Payer: HFN Commercial |
$275.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$275.56
|
| Rate for Payer: Quartz Beloit One Network |
$146.76
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$221.85
|
|
|
Comprehensive Audiology Eval
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
3203512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$284.54 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$26.27
|
| Rate for Payer: Anthem Medicare Advantage |
$26.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.27
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.27
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.27
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$39.41
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$26.27
|
| Rate for Payer: The Alliance Commercial |
$65.68
|
| Rate for Payer: United Healthcare Medicaid |
$41.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.27
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$105.08
|
|
|
Comprehensive Hereditary Cancer Panel
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 81432
|
| Hospital Charge Code |
6173422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$431.63 |
| Max. Negotiated Rate |
$810.41 |
| Rate for Payer: Aetna Commercial |
$792.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.87
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$810.41
|
| Rate for Payer: Health EOS Commercial |
$783.98
|
| Rate for Payer: HFN Commercial |
$810.41
|
| Rate for Payer: Multiplan Commercial |
$704.70
|
| Rate for Payer: Preferred Network Access Commercial |
$810.41
|
| Rate for Payer: Quartz Beloit One Network |
$431.63
|
| Rate for Payer: Quartz Commercial |
$528.53
|
| Rate for Payer: WEA Trust Commercial |
$484.48
|
| Rate for Payer: WPS Commercial |
$652.44
|
|
|
Comprehensive Hereditary Cancer Panel
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 81432
|
| Hospital Charge Code |
6173422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$431.63 |
| Max. Negotiated Rate |
$5,424.43 |
| Rate for Payer: Aetna Commercial |
$792.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,648.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,235.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,172.31
|
| Rate for Payer: Anthem Medicare Advantage |
$1,356.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,356.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,356.11
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$810.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,356.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,356.11
|
| Rate for Payer: Health EOS Commercial |
$783.98
|
| Rate for Payer: HFN Commercial |
$810.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,044.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,356.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,356.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,356.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,356.11
|
| Rate for Payer: Multiplan Commercial |
$704.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,034.16
|
| Rate for Payer: Preferred Network Access Commercial |
$810.41
|
| Rate for Payer: Quartz Beloit One Network |
$431.63
|
| Rate for Payer: Quartz Commercial |
$572.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.11
|
| Rate for Payer: The Alliance Commercial |
$5,424.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,356.11
|
| Rate for Payer: United Healthcare PPO |
$660.66
|
| Rate for Payer: WEA Trust Commercial |
$484.48
|
| Rate for Payer: Wellcare Medicare |
$1,356.11
|
| Rate for Payer: WPS Commercial |
$652.44
|
|
|
Comprehensive Hereditary Cancer Panel
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
CPT 81432
|
| Hospital Charge Code |
6173422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$387.59 |
| Max. Negotiated Rate |
$5,966.88 |
| Rate for Payer: Aetna Commercial |
$836.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.11
|
| Rate for Payer: Anthem Medicare Advantage |
$1,356.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,356.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,356.11
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$836.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.11
|
| Rate for Payer: Health EOS Commercial |
$801.60
|
| Rate for Payer: HFN Commercial |
$836.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,492.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,492.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,356.11
|
| Rate for Payer: Multiplan Commercial |
$704.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,034.16
|
| Rate for Payer: Preferred Network Access Commercial |
$836.84
|
| Rate for Payer: Quartz Beloit One Network |
$387.59
|
| Rate for Payer: Quartz Commercial |
$502.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.11
|
| Rate for Payer: The Alliance Commercial |
$5,356.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,356.11
|
| Rate for Payer: WEA Trust Commercial |
$484.48
|
| Rate for Payer: WPS Commercial |
$5,966.88
|
|
|
Comprehensive Metabolic Panel
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$10.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.23
|
| Rate for Payer: Anthem Medicare Advantage |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.98
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.98
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.98
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$16.47
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10.98
|
| Rate for Payer: The Alliance Commercial |
$43.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.98
|
| Rate for Payer: United Healthcare PPO |
$262.86
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: Wellcare Medicare |
$10.98
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Comprehensive Metabolic Panel
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$10.98
|
| Rate for Payer: Anthem Medicare Advantage |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.98
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$332.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.98
|
| Rate for Payer: Health EOS Commercial |
$318.94
|
| Rate for Payer: HFN Commercial |
$332.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.98
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$16.47
|
| Rate for Payer: Preferred Network Access Commercial |
$332.96
|
| Rate for Payer: Quartz Beloit One Network |
$154.21
|
| Rate for Payer: Quartz Commercial |
$199.77
|
| Rate for Payer: Quartz Medicare Advantage |
$10.98
|
| Rate for Payer: The Alliance Commercial |
$43.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.98
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$48.32
|
|
|
Comprehensive Metabolic Panel
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
633709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
COMPRESSION GLOVER 3/4 SM (L) #9274-40-02
|
Facility
|
OP
|
$258.00
|
|
| Hospital Charge Code |
2969808
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
COMPRESSION GLOVER 3/4 SM (L) #9274-40-02
|
Facility
|
IP
|
$258.00
|
|
| Hospital Charge Code |
2969808
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
COMPRESSION PLATE 5.0 BROAD 11 HL 627571
|
Facility
|
IP
|
$9,835.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,011.92 |
| Max. Negotiated Rate |
$9,410.13 |
| Rate for Payer: Aetna Commercial |
$9,205.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,796.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,421.05
|
| Rate for Payer: Cash Price |
$2,950.50
|
| Rate for Payer: Cigna Commercial |
$9,410.13
|
| Rate for Payer: Health EOS Commercial |
$9,103.28
|
| Rate for Payer: HFN Commercial |
$9,410.13
|
| Rate for Payer: Multiplan Commercial |
$8,182.72
|
| Rate for Payer: Preferred Network Access Commercial |
$9,410.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,011.92
|
| Rate for Payer: Quartz Commercial |
$6,137.04
|
| Rate for Payer: WEA Trust Commercial |
$5,625.62
|
| Rate for Payer: WPS Commercial |
$7,575.90
|
|
|
COMPRESSION PLATE 5.0 BROAD 11 HL 627571
|
Facility
|
OP
|
$9,835.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.95 |
| Max. Negotiated Rate |
$9,410.13 |
| Rate for Payer: Aetna Commercial |
$9,205.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,796.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,863.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,648.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,114.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,909.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,421.05
|
| Rate for Payer: Cash Price |
$2,950.50
|
| Rate for Payer: Cigna Commercial |
$9,410.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,723.97
|
| Rate for Payer: Health EOS Commercial |
$9,103.28
|
| Rate for Payer: HFN Commercial |
$9,410.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,671.30
|
| Rate for Payer: Multiplan Commercial |
$8,182.72
|
| Rate for Payer: NAPHCARE Commercial |
$6,137.04
|
| Rate for Payer: Preferred Network Access Commercial |
$9,410.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,011.92
|
| Rate for Payer: Quartz Commercial |
$6,648.46
|
| Rate for Payer: Quartz Medicare Advantage |
$6,137.04
|
| Rate for Payer: The Alliance Commercial |
$5,114.20
|
| Rate for Payer: WEA Trust Commercial |
$5,625.62
|
| Rate for Payer: WPS Commercial |
$7,575.90
|
|
|
COMPRESSION SCREW 32.3MM OMEGA 596001S
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.33 |
| Max. Negotiated Rate |
$855.38 |
| Rate for Payer: Aetna Commercial |
$836.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$799.59
|
| Rate for Payer: Aetna Managed Medicare |
$260.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$604.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$464.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$446.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$492.77
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cigna Commercial |
$855.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$520.31
|
| Rate for Payer: Health EOS Commercial |
$827.49
|
| Rate for Payer: HFN Commercial |
$855.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$697.32
|
| Rate for Payer: Multiplan Commercial |
$743.81
|
| Rate for Payer: NAPHCARE Commercial |
$557.86
|
| Rate for Payer: Preferred Network Access Commercial |
$855.38
|
| Rate for Payer: Quartz Beloit One Network |
$455.58
|
| Rate for Payer: Quartz Commercial |
$604.34
|
| Rate for Payer: Quartz Medicare Advantage |
$557.86
|
| Rate for Payer: The Alliance Commercial |
$464.88
|
| Rate for Payer: WEA Trust Commercial |
$511.37
|
| Rate for Payer: WPS Commercial |
$688.65
|
|
|
COMPRESSION SCREW 32.3MM OMEGA 596001S
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.58 |
| Max. Negotiated Rate |
$855.38 |
| Rate for Payer: Aetna Commercial |
$836.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$799.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$492.77
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cigna Commercial |
$855.38
|
| Rate for Payer: Health EOS Commercial |
$827.49
|
| Rate for Payer: HFN Commercial |
$855.38
|
| Rate for Payer: Multiplan Commercial |
$743.81
|
| Rate for Payer: Preferred Network Access Commercial |
$855.38
|
| Rate for Payer: Quartz Beloit One Network |
$455.58
|
| Rate for Payer: Quartz Commercial |
$557.86
|
| Rate for Payer: WEA Trust Commercial |
$511.37
|
| Rate for Payer: WPS Commercial |
$688.65
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 18MM SCREW WHITE EQUINOXE REVERSE SHOULDER 320-20-18
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Aetna Managed Medicare |
$331.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.25
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.55
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: NAPHCARE Commercial |
$710.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$769.21
|
| Rate for Payer: Quartz Medicare Advantage |
$710.04
|
| Rate for Payer: The Alliance Commercial |
$591.70
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 18MM SCREW WHITE EQUINOXE REVERSE SHOULDER 320-20-18
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.87 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 22MM SCREW BLACK EQUINOXE REVERSE SHOULDER 320-20-22
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.87 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 22MM SCREW BLACK EQUINOXE REVERSE SHOULDER 320-20-22
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Aetna Managed Medicare |
$331.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.25
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.55
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: NAPHCARE Commercial |
$710.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$769.21
|
| Rate for Payer: Quartz Medicare Advantage |
$710.04
|
| Rate for Payer: The Alliance Commercial |
$591.70
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 30MM SCREW BLUE EQUINOXE REVERSE SHOULDER 320-20-30
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Aetna Managed Medicare |
$331.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.25
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.55
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: NAPHCARE Commercial |
$710.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$769.21
|
| Rate for Payer: Quartz Medicare Advantage |
$710.04
|
| Rate for Payer: The Alliance Commercial |
$591.70
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 30MM SCREW BLUE EQUINOXE REVERSE SHOULDER 320-20-30
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.87 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 34MM SCREW RED EQUINOXE REVERSE SHOULDER 320-20-34
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.87 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 34MM SCREW RED EQUINOXE REVERSE SHOULDER 320-20-34
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Aetna Managed Medicare |
$331.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.25
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.55
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: NAPHCARE Commercial |
$710.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$769.21
|
| Rate for Payer: Quartz Medicare Advantage |
$710.04
|
| Rate for Payer: The Alliance Commercial |
$591.70
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
