|
END CAP FEMORAL NAIL TI 5MM 04.233.005S
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.35 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,582.46
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
END CAP FEMORAL NAIL TI 5MM 04.233.005S
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Aetna Managed Medicare |
$738.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.95
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.08
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,714.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.46
|
| Rate for Payer: The Alliance Commercial |
$1,318.72
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
END CAP FOR APEX PIN 04 5027-1-040
|
Facility
|
IP
|
$483.00
|
|
| Hospital Charge Code |
6167873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.14 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$301.39
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
END CAP FOR APEX PIN 04 5027-1-040
|
Facility
|
OP
|
$483.00
|
|
| Hospital Charge Code |
6167873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Aetna Managed Medicare |
$140.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.11
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.74
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: NAPHCARE Commercial |
$301.39
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$326.51
|
| Rate for Payer: Quartz Medicare Advantage |
$301.39
|
| Rate for Payer: The Alliance Commercial |
$251.16
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
END CAP FOR APEX PIN 05 5027-1-050
|
Facility
|
OP
|
$476.00
|
|
| Hospital Charge Code |
5603591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$455.44 |
| Rate for Payer: Aetna Commercial |
$445.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Aetna Managed Medicare |
$138.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$321.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$237.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.37
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$455.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.03
|
| Rate for Payer: Health EOS Commercial |
$440.59
|
| Rate for Payer: HFN Commercial |
$455.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$371.28
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: NAPHCARE Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$455.44
|
| Rate for Payer: Quartz Beloit One Network |
$242.57
|
| Rate for Payer: Quartz Commercial |
$321.78
|
| Rate for Payer: Quartz Medicare Advantage |
$297.02
|
| Rate for Payer: The Alliance Commercial |
$247.52
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: WPS Commercial |
$366.66
|
|
|
END CAP FOR APEX PIN 05 5027-1-050
|
Facility
|
IP
|
$476.00
|
|
| Hospital Charge Code |
5603591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.57 |
| Max. Negotiated Rate |
$455.44 |
| Rate for Payer: Aetna Commercial |
$445.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.37
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$455.44
|
| Rate for Payer: Health EOS Commercial |
$440.59
|
| Rate for Payer: HFN Commercial |
$455.44
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: Preferred Network Access Commercial |
$455.44
|
| Rate for Payer: Quartz Beloit One Network |
$242.57
|
| Rate for Payer: Quartz Commercial |
$297.02
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: WPS Commercial |
$366.66
|
|
|
END CAP OMM EXTENSION TI 04.004.000S
|
Facility
|
OP
|
$2,556.00
|
|
| Hospital Charge Code |
2966231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.31 |
| Max. Negotiated Rate |
$2,445.58 |
| Rate for Payer: Aetna Commercial |
$2,392.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.09
|
| Rate for Payer: Aetna Managed Medicare |
$744.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,727.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,275.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,408.87
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$2,445.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,487.59
|
| Rate for Payer: Health EOS Commercial |
$2,365.83
|
| Rate for Payer: HFN Commercial |
$2,445.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,993.68
|
| Rate for Payer: Multiplan Commercial |
$2,126.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.54
|
| Rate for Payer: Quartz Commercial |
$1,727.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,594.94
|
| Rate for Payer: The Alliance Commercial |
$1,329.12
|
| Rate for Payer: WEA Trust Commercial |
$1,462.03
|
| Rate for Payer: WPS Commercial |
$1,968.89
|
|
|
END CAP OMM EXTENSION TI 04.004.000S
|
Facility
|
IP
|
$2,556.00
|
|
| Hospital Charge Code |
2966231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.54 |
| Max. Negotiated Rate |
$2,445.58 |
| Rate for Payer: Aetna Commercial |
$2,392.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,408.87
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$2,445.58
|
| Rate for Payer: Health EOS Commercial |
$2,365.83
|
| Rate for Payer: HFN Commercial |
$2,445.58
|
| Rate for Payer: Multiplan Commercial |
$2,126.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.54
|
| Rate for Payer: Quartz Commercial |
$1,594.94
|
| Rate for Payer: WEA Trust Commercial |
$1,462.03
|
| Rate for Payer: WPS Commercial |
$1,968.89
|
|
|
END CAP SCN 1826-0003S
|
Facility
|
OP
|
$2,052.00
|
|
| Hospital Charge Code |
3072610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.54 |
| Max. Negotiated Rate |
$1,963.35 |
| Rate for Payer: Aetna Commercial |
$1,920.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,835.31
|
| Rate for Payer: Aetna Managed Medicare |
$597.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,387.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,067.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,024.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.06
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,963.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,194.26
|
| Rate for Payer: Health EOS Commercial |
$1,899.33
|
| Rate for Payer: HFN Commercial |
$1,963.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,600.56
|
| Rate for Payer: Multiplan Commercial |
$1,707.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,963.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.70
|
| Rate for Payer: Quartz Commercial |
$1,387.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,280.45
|
| Rate for Payer: The Alliance Commercial |
$1,067.04
|
| Rate for Payer: WEA Trust Commercial |
$1,173.74
|
| Rate for Payer: WPS Commercial |
$1,580.66
|
|
|
END CAP SCN 1826-0003S
|
Facility
|
IP
|
$2,052.00
|
|
| Hospital Charge Code |
3072610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.70 |
| Max. Negotiated Rate |
$1,963.35 |
| Rate for Payer: Aetna Commercial |
$1,920.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,835.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.06
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,963.35
|
| Rate for Payer: Health EOS Commercial |
$1,899.33
|
| Rate for Payer: HFN Commercial |
$1,963.35
|
| Rate for Payer: Multiplan Commercial |
$1,707.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,963.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.70
|
| Rate for Payer: Quartz Commercial |
$1,280.45
|
| Rate for Payer: WEA Trust Commercial |
$1,173.74
|
| Rate for Payer: WPS Commercial |
$1,580.66
|
|
|
END CAP TIBIAL NAIL 5MM TI 04.045.855S
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.35 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,582.46
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
END CAP TIBIAL NAIL 5MM TI 04.045.855S
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Aetna Managed Medicare |
$738.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.95
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.08
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,714.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.46
|
| Rate for Payer: The Alliance Commercial |
$1,318.72
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
END CAP TIBIAL NAIL 5MM TI 04.045.865S
|
Facility
|
OP
|
$2,438.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6180622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.95 |
| Max. Negotiated Rate |
$2,332.68 |
| Rate for Payer: Aetna Commercial |
$2,281.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.55
|
| Rate for Payer: Aetna Managed Medicare |
$709.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,267.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,343.83
|
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cigna Commercial |
$2,332.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,418.92
|
| Rate for Payer: Health EOS Commercial |
$2,256.61
|
| Rate for Payer: HFN Commercial |
$2,332.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,901.64
|
| Rate for Payer: Multiplan Commercial |
$2,028.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,332.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.40
|
| Rate for Payer: Quartz Commercial |
$1,648.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.31
|
| Rate for Payer: The Alliance Commercial |
$1,267.76
|
| Rate for Payer: WEA Trust Commercial |
$1,394.54
|
| Rate for Payer: WPS Commercial |
$1,877.99
|
|
|
END CAP TIBIAL NAIL 5MM TI 04.045.865S
|
Facility
|
IP
|
$2,438.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6180622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.40 |
| Max. Negotiated Rate |
$2,332.68 |
| Rate for Payer: Aetna Commercial |
$2,281.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,343.83
|
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cigna Commercial |
$2,332.68
|
| Rate for Payer: Health EOS Commercial |
$2,256.61
|
| Rate for Payer: HFN Commercial |
$2,332.68
|
| Rate for Payer: Multiplan Commercial |
$2,028.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,332.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.40
|
| Rate for Payer: Quartz Commercial |
$1,521.31
|
| Rate for Payer: WEA Trust Commercial |
$1,394.54
|
| Rate for Payer: WPS Commercial |
$1,877.99
|
|
|
END CAP TITANIUM 0MM EXTENSION
|
Facility
|
OP
|
$2,521.00
|
|
| Hospital Charge Code |
2966230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.12 |
| Max. Negotiated Rate |
$2,412.09 |
| Rate for Payer: Aetna Commercial |
$2,359.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Aetna Managed Medicare |
$734.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,310.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.58
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,412.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.22
|
| Rate for Payer: Health EOS Commercial |
$2,333.44
|
| Rate for Payer: HFN Commercial |
$2,412.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,966.38
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.70
|
| Rate for Payer: Quartz Commercial |
$1,704.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,573.10
|
| Rate for Payer: The Alliance Commercial |
$1,310.92
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
END CAP TITANIUM 0MM EXTENSION
|
Facility
|
IP
|
$2,521.00
|
|
| Hospital Charge Code |
2966230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.70 |
| Max. Negotiated Rate |
$2,412.09 |
| Rate for Payer: Aetna Commercial |
$2,359.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.58
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,412.09
|
| Rate for Payer: Health EOS Commercial |
$2,333.44
|
| Rate for Payer: HFN Commercial |
$2,412.09
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.70
|
| Rate for Payer: Quartz Commercial |
$1,573.10
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
ENDOCAVITY BALLOON ACCUCARE 610-898
|
Facility
|
IP
|
$843.00
|
|
| Hospital Charge Code |
5459008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$429.59 |
| Max. Negotiated Rate |
$806.58 |
| Rate for Payer: Aetna Commercial |
$789.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.66
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$806.58
|
| Rate for Payer: Health EOS Commercial |
$780.28
|
| Rate for Payer: HFN Commercial |
$806.58
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: Preferred Network Access Commercial |
$806.58
|
| Rate for Payer: Quartz Beloit One Network |
$429.59
|
| Rate for Payer: Quartz Commercial |
$526.03
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$649.36
|
|
|
ENDOCAVITY BALLOON ACCUCARE 610-898
|
Facility
|
OP
|
$843.00
|
|
| Hospital Charge Code |
5459008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$806.58 |
| Rate for Payer: Aetna Commercial |
$789.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Aetna Managed Medicare |
$245.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.66
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$806.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.63
|
| Rate for Payer: Health EOS Commercial |
$780.28
|
| Rate for Payer: HFN Commercial |
$806.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.54
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: NAPHCARE Commercial |
$526.03
|
| Rate for Payer: Preferred Network Access Commercial |
$806.58
|
| Rate for Payer: Quartz Beloit One Network |
$429.59
|
| Rate for Payer: Quartz Commercial |
$569.87
|
| Rate for Payer: Quartz Medicare Advantage |
$526.03
|
| Rate for Payer: The Alliance Commercial |
$438.36
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$649.36
|
|
|
Endocervical Curettage 57505
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
1188888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.82 |
| Max. Negotiated Rate |
$432.53 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$96.12
|
| Rate for Payer: Anthem Medicare Advantage |
$96.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.12
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$340.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.12
|
| Rate for Payer: Health EOS Commercial |
$326.51
|
| Rate for Payer: HFN Commercial |
$340.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.12
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$144.18
|
| Rate for Payer: Preferred Network Access Commercial |
$340.86
|
| Rate for Payer: Quartz Beloit One Network |
$157.87
|
| Rate for Payer: Quartz Commercial |
$204.52
|
| Rate for Payer: Quartz Medicare Advantage |
$96.12
|
| Rate for Payer: The Alliance Commercial |
$408.50
|
| Rate for Payer: United Healthcare Medicaid |
$62.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.12
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$432.53
|
|
|
ENDOCLIP 5MM CLIP APPLIER 176620
|
Facility
|
OP
|
$4,538.00
|
|
| Hospital Charge Code |
2963073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,321.47 |
| Max. Negotiated Rate |
$4,341.96 |
| Rate for Payer: Aetna Commercial |
$4,247.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,058.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,321.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,067.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,359.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,265.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,501.35
|
| Rate for Payer: Cash Price |
$1,361.40
|
| Rate for Payer: Cigna Commercial |
$4,341.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,641.12
|
| Rate for Payer: Health EOS Commercial |
$4,200.37
|
| Rate for Payer: HFN Commercial |
$4,341.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,539.64
|
| Rate for Payer: Multiplan Commercial |
$3,775.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,831.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,341.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,312.56
|
| Rate for Payer: Quartz Commercial |
$3,067.69
|
| Rate for Payer: Quartz Medicare Advantage |
$2,831.71
|
| Rate for Payer: The Alliance Commercial |
$2,359.76
|
| Rate for Payer: WEA Trust Commercial |
$2,595.74
|
| Rate for Payer: WPS Commercial |
$3,495.62
|
|
|
ENDOCLIP 5MM CLIP APPLIER 176620
|
Facility
|
IP
|
$4,538.00
|
|
| Hospital Charge Code |
2963073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,312.56 |
| Max. Negotiated Rate |
$4,341.96 |
| Rate for Payer: Aetna Commercial |
$4,247.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,058.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,501.35
|
| Rate for Payer: Cash Price |
$1,361.40
|
| Rate for Payer: Cigna Commercial |
$4,341.96
|
| Rate for Payer: Health EOS Commercial |
$4,200.37
|
| Rate for Payer: HFN Commercial |
$4,341.96
|
| Rate for Payer: Multiplan Commercial |
$3,775.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,341.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,312.56
|
| Rate for Payer: Quartz Commercial |
$2,831.71
|
| Rate for Payer: WEA Trust Commercial |
$2,595.74
|
| Rate for Payer: WPS Commercial |
$3,495.62
|
|
|
ENDOCLIP 5MM ENDOSCOPIC MULTIPLE CLIP APPLIER EL5ML
|
Facility
|
OP
|
$5,776.00
|
|
| Hospital Charge Code |
4283272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,681.97 |
| Max. Negotiated Rate |
$5,526.48 |
| Rate for Payer: Aetna Commercial |
$5,406.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,166.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,681.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,904.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,003.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,883.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,183.73
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cigna Commercial |
$5,526.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,361.63
|
| Rate for Payer: Health EOS Commercial |
$5,346.27
|
| Rate for Payer: HFN Commercial |
$5,526.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,505.28
|
| Rate for Payer: Multiplan Commercial |
$4,805.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,604.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,526.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,943.45
|
| Rate for Payer: Quartz Commercial |
$3,904.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,604.22
|
| Rate for Payer: The Alliance Commercial |
$3,003.52
|
| Rate for Payer: WEA Trust Commercial |
$3,303.87
|
| Rate for Payer: WPS Commercial |
$4,449.25
|
|
|
ENDOCLIP 5MM ENDOSCOPIC MULTIPLE CLIP APPLIER EL5ML
|
Facility
|
IP
|
$5,776.00
|
|
| Hospital Charge Code |
4283272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,943.45 |
| Max. Negotiated Rate |
$5,526.48 |
| Rate for Payer: Aetna Commercial |
$5,406.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,166.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,183.73
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cigna Commercial |
$5,526.48
|
| Rate for Payer: Health EOS Commercial |
$5,346.27
|
| Rate for Payer: HFN Commercial |
$5,526.48
|
| Rate for Payer: Multiplan Commercial |
$4,805.63
|
| Rate for Payer: Preferred Network Access Commercial |
$5,526.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,943.45
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: WEA Trust Commercial |
$3,303.87
|
| Rate for Payer: WPS Commercial |
$4,449.25
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$29,688.88
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$8,356.43 |
| Max. Negotiated Rate |
$29,688.88 |
| Rate for Payer: Aetna Managed Medicare |
$8,356.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,364.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,142.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,286.35
|
| Rate for Payer: Anthem Medicare Advantage |
$8,356.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,356.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,356.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,356.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,079.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,356.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,531.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,356.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,356.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,356.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,356.43
|
| Rate for Payer: NAPHCARE Commercial |
$12,534.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8,356.43
|
| Rate for Payer: The Alliance Commercial |
$29,688.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,356.43
|
| Rate for Payer: United Healthcare PPO |
$16,762.38
|
| Rate for Payer: Wellcare Medicare |
$8,356.43
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$45,819.28
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$13,112.92 |
| Max. Negotiated Rate |
$45,819.28 |
| Rate for Payer: Aetna Managed Medicare |
$13,112.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,916.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,529.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,155.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,112.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,112.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,112.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,112.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,034.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,112.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,362.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,112.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,112.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,112.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,112.92
|
| Rate for Payer: NAPHCARE Commercial |
$19,669.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13,112.92
|
| Rate for Payer: The Alliance Commercial |
$45,819.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,112.92
|
| Rate for Payer: United Healthcare PPO |
$25,973.23
|
| Rate for Payer: Wellcare Medicare |
$13,112.92
|
|
