|
Coude* - Urinary Catheter Type:
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510856
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.09
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
Counseling Care Urine Drug Screen
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
4605712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$71.30 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.59
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$26.74
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$71.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare PPO |
$42.90
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: Wellcare Medicare |
$17.83
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Counseling Care Urine Drug Screen
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
4605712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Counseling Care Urine Drug Screen
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
4605712
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$78.43 |
| Rate for Payer: Aetna Commercial |
$54.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$54.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$52.05
|
| Rate for Payer: HFN Commercial |
$54.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$26.74
|
| Rate for Payer: Preferred Network Access Commercial |
$54.34
|
| Rate for Payer: Quartz Beloit One Network |
$25.17
|
| Rate for Payer: Quartz Commercial |
$32.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$70.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$78.43
|
|
|
COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY
|
Facility
|
OP
|
$81.24
|
|
|
Service Code
|
EAPG 00315
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$81.24 |
| Rate for Payer: Anthem Medicaid |
$78.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$78.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.11
|
| Rate for Payer: Dean Health Medicaid |
$78.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$78.11
|
| Rate for Payer: Managed Health Services Medicaid |
$81.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$78.11
|
| Rate for Payer: United Healthcare Medicaid |
$78.11
|
|
|
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 |
$1,619.51 |
| Max. Negotiated Rate |
$3,040.71 |
| Rate for Payer: Aetna Commercial |
$2,974.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,842.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,751.71
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$3,040.71
|
| Rate for Payer: Health EOS Commercial |
$2,941.56
|
| Rate for Payer: HFN Commercial |
$3,040.71
|
| Rate for Payer: Multiplan Commercial |
$2,644.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,040.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,619.51
|
| Rate for Payer: Quartz Commercial |
$1,983.07
|
| Rate for Payer: WEA Trust Commercial |
$1,817.82
|
| Rate for Payer: WPS Commercial |
$2,448.01
|
|
|
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 |
$925.43 |
| Max. Negotiated Rate |
$3,040.71 |
| Rate for Payer: Aetna Commercial |
$2,974.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,842.40
|
| Rate for Payer: Aetna Managed Medicare |
$925.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,148.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,652.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,586.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,751.71
|
| Rate for Payer: Cash Price |
$953.40
|
| Rate for Payer: Cigna Commercial |
$3,040.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,849.60
|
| Rate for Payer: Health EOS Commercial |
$2,941.56
|
| Rate for Payer: HFN Commercial |
$3,040.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,478.84
|
| Rate for Payer: Multiplan Commercial |
$2,644.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,983.07
|
| Rate for Payer: Preferred Network Access Commercial |
$3,040.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,619.51
|
| Rate for Payer: Quartz Commercial |
$2,148.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,983.07
|
| Rate for Payer: The Alliance Commercial |
$1,652.56
|
| Rate for Payer: WEA Trust Commercial |
$1,817.82
|
| Rate for Payer: WPS Commercial |
$2,448.01
|
|
|
COUNTERSINK 5.0 CANNULATE DSDS1050
|
Facility
|
IP
|
$1,983.00
|
|
| Hospital Charge Code |
5547330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.54 |
| Max. Negotiated Rate |
$1,897.33 |
| Rate for Payer: Aetna Commercial |
$1,856.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.03
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,897.33
|
| Rate for Payer: Health EOS Commercial |
$1,835.46
|
| Rate for Payer: HFN Commercial |
$1,897.33
|
| Rate for Payer: Multiplan Commercial |
$1,649.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.54
|
| Rate for Payer: Quartz Commercial |
$1,237.39
|
| Rate for Payer: WEA Trust Commercial |
$1,134.28
|
| Rate for Payer: WPS Commercial |
$1,527.50
|
|
|
COUNTERSINK 5.0 CANNULATE DSDS1050
|
Facility
|
OP
|
$1,983.00
|
|
| Hospital Charge Code |
5547330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.45 |
| Max. Negotiated Rate |
$1,897.33 |
| Rate for Payer: Aetna Commercial |
$1,856.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.60
|
| Rate for Payer: Aetna Managed Medicare |
$577.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,340.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,031.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$989.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.03
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,897.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,154.11
|
| Rate for Payer: Health EOS Commercial |
$1,835.46
|
| Rate for Payer: HFN Commercial |
$1,897.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,546.74
|
| Rate for Payer: Multiplan Commercial |
$1,649.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.54
|
| Rate for Payer: Quartz Commercial |
$1,340.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,237.39
|
| Rate for Payer: The Alliance Commercial |
$1,031.16
|
| Rate for Payer: WEA Trust Commercial |
$1,134.28
|
| Rate for Payer: WPS Commercial |
$1,527.50
|
|
|
COUNTERSINK 6.0 CANNULATE DSDS1060
|
Facility
|
IP
|
$2,012.00
|
|
| Hospital Charge Code |
6173854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.32 |
| Max. Negotiated Rate |
$1,925.08 |
| Rate for Payer: Aetna Commercial |
$1,883.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,799.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,109.01
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,925.08
|
| Rate for Payer: Health EOS Commercial |
$1,862.31
|
| Rate for Payer: HFN Commercial |
$1,925.08
|
| Rate for Payer: Multiplan Commercial |
$1,673.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,925.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,025.32
|
| Rate for Payer: Quartz Commercial |
$1,255.49
|
| Rate for Payer: WEA Trust Commercial |
$1,150.86
|
| Rate for Payer: WPS Commercial |
$1,549.84
|
|
|
COUNTERSINK 6.0 CANNULATE DSDS1060
|
Facility
|
OP
|
$2,012.00
|
|
| Hospital Charge Code |
6173854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.89 |
| Max. Negotiated Rate |
$1,925.08 |
| Rate for Payer: Aetna Commercial |
$1,883.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,799.53
|
| Rate for Payer: Aetna Managed Medicare |
$585.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,360.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,046.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,004.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,109.01
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,925.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,170.98
|
| Rate for Payer: Health EOS Commercial |
$1,862.31
|
| Rate for Payer: HFN Commercial |
$1,925.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,569.36
|
| Rate for Payer: Multiplan Commercial |
$1,673.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,255.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,925.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,025.32
|
| Rate for Payer: Quartz Commercial |
$1,360.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,255.49
|
| Rate for Payer: The Alliance Commercial |
$1,046.24
|
| Rate for Payer: WEA Trust Commercial |
$1,150.86
|
| Rate for Payer: WPS Commercial |
$1,549.84
|
|
|
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 |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
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 |
$492.71 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
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 |
$1,613.39 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$1,975.58
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
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 |
$921.94 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Aetna Managed Medicare |
$921.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,140.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,646.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,842.61
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,469.48
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,975.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$2,140.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,975.58
|
| Rate for Payer: The Alliance Commercial |
$1,646.32
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
COUNTERSINK CANN 2.8MM AO 45-20007S
|
Facility
|
OP
|
$2,080.00
|
|
| Hospital Charge Code |
6171705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.70 |
| Max. Negotiated Rate |
$1,990.14 |
| Rate for Payer: Aetna Commercial |
$1,946.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,860.35
|
| Rate for Payer: Aetna Managed Medicare |
$605.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,406.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,038.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,146.50
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$1,990.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,210.56
|
| Rate for Payer: Health EOS Commercial |
$1,925.25
|
| Rate for Payer: HFN Commercial |
$1,990.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,622.40
|
| Rate for Payer: Multiplan Commercial |
$1,730.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,990.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.97
|
| Rate for Payer: Quartz Commercial |
$1,406.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,297.92
|
| Rate for Payer: The Alliance Commercial |
$1,081.60
|
| Rate for Payer: WEA Trust Commercial |
$1,189.76
|
| Rate for Payer: WPS Commercial |
$1,602.22
|
|
|
COUNTERSINK CANN 2.8MM AO 45-20007S
|
Facility
|
IP
|
$2,080.00
|
|
| Hospital Charge Code |
6171705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,059.97 |
| Max. Negotiated Rate |
$1,990.14 |
| Rate for Payer: Aetna Commercial |
$1,946.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,860.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,146.50
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$1,990.14
|
| Rate for Payer: Health EOS Commercial |
$1,925.25
|
| Rate for Payer: HFN Commercial |
$1,990.14
|
| Rate for Payer: Multiplan Commercial |
$1,730.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,990.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.97
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: WEA Trust Commercial |
$1,189.76
|
| Rate for Payer: WPS Commercial |
$1,602.22
|
|
|
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 |
$1,553.26 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$1,901.95
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
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 |
$887.58 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Aetna Managed Medicare |
$887.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,060.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,584.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,521.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,773.94
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,377.44
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,901.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$2,060.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,901.95
|
| Rate for Payer: The Alliance Commercial |
$1,584.96
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
COUNTERSINK CANN 3.8MM AO 45-30007S
|
Facility
|
OP
|
$1,932.00
|
|
| Hospital Charge Code |
6171707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,848.54 |
| Rate for Payer: Aetna Commercial |
$1,808.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.98
|
| Rate for Payer: Aetna Managed Medicare |
$562.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,306.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,004.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$964.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,064.92
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,848.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,124.42
|
| Rate for Payer: Health EOS Commercial |
$1,788.26
|
| Rate for Payer: HFN Commercial |
$1,848.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,607.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.54
|
| Rate for Payer: Quartz Beloit One Network |
$984.55
|
| Rate for Payer: Quartz Commercial |
$1,306.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,205.57
|
| Rate for Payer: The Alliance Commercial |
$1,004.64
|
| Rate for Payer: WEA Trust Commercial |
$1,105.10
|
| Rate for Payer: WPS Commercial |
$1,488.22
|
|
|
COUNTERSINK CANN 3.8MM AO 45-30007S
|
Facility
|
IP
|
$1,932.00
|
|
| Hospital Charge Code |
6171707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$984.55 |
| Max. Negotiated Rate |
$1,848.54 |
| Rate for Payer: Aetna Commercial |
$1,808.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,064.92
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,848.54
|
| Rate for Payer: Health EOS Commercial |
$1,788.26
|
| Rate for Payer: HFN Commercial |
$1,848.54
|
| Rate for Payer: Multiplan Commercial |
$1,607.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.54
|
| Rate for Payer: Quartz Beloit One Network |
$984.55
|
| Rate for Payer: Quartz Commercial |
$1,205.57
|
| Rate for Payer: WEA Trust Commercial |
$1,105.10
|
| Rate for Payer: WPS Commercial |
$1,488.22
|
|
|
COUNTERSINK CANN 4.0MM AO COUPLING STRYKER 702473
|
Facility
|
OP
|
$1,891.00
|
|
| Hospital Charge Code |
6185030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$1,809.31 |
| Rate for Payer: Aetna Commercial |
$1,769.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,691.31
|
| Rate for Payer: Aetna Managed Medicare |
$550.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,278.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$983.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$943.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.32
|
| Rate for Payer: Cash Price |
$567.30
|
| Rate for Payer: Cigna Commercial |
$1,809.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,100.56
|
| Rate for Payer: Health EOS Commercial |
$1,750.31
|
| Rate for Payer: HFN Commercial |
$1,809.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,474.98
|
| Rate for Payer: Multiplan Commercial |
$1,573.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,179.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,809.31
|
| Rate for Payer: Quartz Beloit One Network |
$963.65
|
| Rate for Payer: Quartz Commercial |
$1,278.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,179.98
|
| Rate for Payer: The Alliance Commercial |
$983.32
|
| Rate for Payer: WEA Trust Commercial |
$1,081.65
|
| Rate for Payer: WPS Commercial |
$1,456.64
|
|
|
COUNTERSINK CANN 4.0MM AO COUPLING STRYKER 702473
|
Facility
|
IP
|
$1,891.00
|
|
| Hospital Charge Code |
6185030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$963.65 |
| Max. Negotiated Rate |
$1,809.31 |
| Rate for Payer: Aetna Commercial |
$1,769.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,691.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.32
|
| Rate for Payer: Cash Price |
$567.30
|
| Rate for Payer: Cigna Commercial |
$1,809.31
|
| Rate for Payer: Health EOS Commercial |
$1,750.31
|
| Rate for Payer: HFN Commercial |
$1,809.31
|
| Rate for Payer: Multiplan Commercial |
$1,573.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,809.31
|
| Rate for Payer: Quartz Beloit One Network |
$963.65
|
| Rate for Payer: Quartz Commercial |
$1,179.98
|
| Rate for Payer: WEA Trust Commercial |
$1,081.65
|
| Rate for Payer: WPS Commercial |
$1,456.64
|
|
|
COUNTERSINK CANN 4.0MM AO FITTING 705260
|
Facility
|
IP
|
$3,376.00
|
|
| Hospital Charge Code |
5729731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,720.41 |
| Max. Negotiated Rate |
$3,230.16 |
| Rate for Payer: Aetna Commercial |
$3,159.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,019.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,860.85
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cigna Commercial |
$3,230.16
|
| Rate for Payer: Health EOS Commercial |
$3,124.83
|
| Rate for Payer: HFN Commercial |
$3,230.16
|
| Rate for Payer: Multiplan Commercial |
$2,808.83
|
| Rate for Payer: Preferred Network Access Commercial |
$3,230.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,720.41
|
| Rate for Payer: Quartz Commercial |
$2,106.62
|
| Rate for Payer: WEA Trust Commercial |
$1,931.07
|
| Rate for Payer: WPS Commercial |
$2,600.53
|
|
|
COUNTERSINK CANN 4.0MM AO FITTING 705260
|
Facility
|
OP
|
$3,376.00
|
|
| Hospital Charge Code |
5729731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$983.09 |
| Max. Negotiated Rate |
$3,230.16 |
| Rate for Payer: Aetna Commercial |
$3,159.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,019.49
|
| Rate for Payer: Aetna Managed Medicare |
$983.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,282.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,755.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,685.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,860.85
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cigna Commercial |
$3,230.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,964.83
|
| Rate for Payer: Health EOS Commercial |
$3,124.83
|
| Rate for Payer: HFN Commercial |
$3,230.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,633.28
|
| Rate for Payer: Multiplan Commercial |
$2,808.83
|
| Rate for Payer: NAPHCARE Commercial |
$2,106.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,230.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,720.41
|
| Rate for Payer: Quartz Commercial |
$2,282.18
|
| Rate for Payer: Quartz Medicare Advantage |
$2,106.62
|
| Rate for Payer: The Alliance Commercial |
$1,755.52
|
| Rate for Payer: WEA Trust Commercial |
$1,931.07
|
| Rate for Payer: WPS Commercial |
$2,600.53
|
|
