|
FOOT, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FOOT, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FORAMEN OVALE, REPAIR OF PATENT
|
Facility
|
OP
|
$15,894.00
|
|
| Hospital Charge Code |
2950337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,628.33 |
| Max. Negotiated Rate |
$15,207.38 |
| Rate for Payer: Aetna Commercial |
$14,876.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,215.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,628.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,744.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,264.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,934.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,760.77
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$15,207.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,250.31
|
| Rate for Payer: Health EOS Commercial |
$14,711.49
|
| Rate for Payer: HFN Commercial |
$15,207.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,397.32
|
| Rate for Payer: Multiplan Commercial |
$13,223.81
|
| Rate for Payer: NAPHCARE Commercial |
$9,917.86
|
| Rate for Payer: Preferred Network Access Commercial |
$15,207.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,099.58
|
| Rate for Payer: Quartz Commercial |
$10,744.34
|
| Rate for Payer: Quartz Medicare Advantage |
$9,917.86
|
| Rate for Payer: The Alliance Commercial |
$8,264.88
|
| Rate for Payer: WEA Trust Commercial |
$9,091.37
|
| Rate for Payer: WPS Commercial |
$12,243.15
|
|
|
FORAMEN OVALE, REPAIR OF PATENT
|
Facility
|
IP
|
$15,894.00
|
|
| Hospital Charge Code |
2950337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,099.58 |
| Max. Negotiated Rate |
$15,207.38 |
| Rate for Payer: Aetna Commercial |
$14,876.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,215.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,760.77
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$15,207.38
|
| Rate for Payer: Health EOS Commercial |
$14,711.49
|
| Rate for Payer: HFN Commercial |
$15,207.38
|
| Rate for Payer: Multiplan Commercial |
$13,223.81
|
| Rate for Payer: Preferred Network Access Commercial |
$15,207.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,099.58
|
| Rate for Payer: Quartz Commercial |
$9,917.86
|
| Rate for Payer: WEA Trust Commercial |
$9,091.37
|
| Rate for Payer: WPS Commercial |
$12,243.15
|
|
|
FORCEP 5 MOSQUTO CURV 106-102
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2963651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
FORCEP 5 MOSQUTO CURV 106-102
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2963651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
FORCEP BIOPSY DISP ALLIGATOR
|
Facility
|
IP
|
$1,245.00
|
|
| Hospital Charge Code |
2973776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$634.45 |
| Max. Negotiated Rate |
$1,191.22 |
| Rate for Payer: Aetna Commercial |
$1,165.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,113.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.24
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,191.22
|
| Rate for Payer: Health EOS Commercial |
$1,152.37
|
| Rate for Payer: HFN Commercial |
$1,191.22
|
| Rate for Payer: Multiplan Commercial |
$1,035.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,191.22
|
| Rate for Payer: Quartz Beloit One Network |
$634.45
|
| Rate for Payer: Quartz Commercial |
$776.88
|
| Rate for Payer: WEA Trust Commercial |
$712.14
|
| Rate for Payer: WPS Commercial |
$959.02
|
|
|
FORCEP BIOPSY DISP ALLIGATOR
|
Facility
|
OP
|
$1,245.00
|
|
| Hospital Charge Code |
2973776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.54 |
| Max. Negotiated Rate |
$1,191.22 |
| Rate for Payer: Aetna Commercial |
$1,165.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,113.53
|
| Rate for Payer: Aetna Managed Medicare |
$362.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$841.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$647.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.24
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,191.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.59
|
| Rate for Payer: Health EOS Commercial |
$1,152.37
|
| Rate for Payer: HFN Commercial |
$1,191.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$971.10
|
| Rate for Payer: Multiplan Commercial |
$1,035.84
|
| Rate for Payer: NAPHCARE Commercial |
$776.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,191.22
|
| Rate for Payer: Quartz Beloit One Network |
$634.45
|
| Rate for Payer: Quartz Commercial |
$841.62
|
| Rate for Payer: Quartz Medicare Advantage |
$776.88
|
| Rate for Payer: The Alliance Commercial |
$647.40
|
| Rate for Payer: WEA Trust Commercial |
$712.14
|
| Rate for Payer: WPS Commercial |
$959.02
|
|
|
FORCEP GRASPING 2.5FR 115CM G16702
|
Facility
|
IP
|
$1,635.00
|
|
| Hospital Charge Code |
2965864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$833.20 |
| Max. Negotiated Rate |
$1,564.37 |
| Rate for Payer: Aetna Commercial |
$1,530.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,462.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$901.21
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$1,564.37
|
| Rate for Payer: Health EOS Commercial |
$1,513.36
|
| Rate for Payer: HFN Commercial |
$1,564.37
|
| Rate for Payer: Multiplan Commercial |
$1,360.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,564.37
|
| Rate for Payer: Quartz Beloit One Network |
$833.20
|
| Rate for Payer: Quartz Commercial |
$1,020.24
|
| Rate for Payer: WEA Trust Commercial |
$935.22
|
| Rate for Payer: WPS Commercial |
$1,259.44
|
|
|
FORCEP GRASPING 2.5FR 115CM G16702
|
Facility
|
OP
|
$1,635.00
|
|
| Hospital Charge Code |
2965864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.11 |
| Max. Negotiated Rate |
$1,564.37 |
| Rate for Payer: Aetna Commercial |
$1,530.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,462.34
|
| Rate for Payer: Aetna Managed Medicare |
$476.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,105.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$850.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$816.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$901.21
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$1,564.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$951.57
|
| Rate for Payer: Health EOS Commercial |
$1,513.36
|
| Rate for Payer: HFN Commercial |
$1,564.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,275.30
|
| Rate for Payer: Multiplan Commercial |
$1,360.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,020.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,564.37
|
| Rate for Payer: Quartz Beloit One Network |
$833.20
|
| Rate for Payer: Quartz Commercial |
$1,105.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,020.24
|
| Rate for Payer: The Alliance Commercial |
$850.20
|
| Rate for Payer: WEA Trust Commercial |
$935.22
|
| Rate for Payer: WPS Commercial |
$1,259.44
|
|
|
FORCEP GRASPING DISP FG-52D
|
Facility
|
OP
|
$3,369.00
|
|
| Hospital Charge Code |
2973362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
FORCEP GRASPING DISP FG-52D
|
Facility
|
IP
|
$3,369.00
|
|
| Hospital Charge Code |
2973362
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
FORCEP GRASPING DISP FG-54D
|
Facility
|
OP
|
$3,589.00
|
|
| Hospital Charge Code |
2973405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,045.12 |
| Max. Negotiated Rate |
$3,433.96 |
| Rate for Payer: Aetna Commercial |
$3,359.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,210.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,045.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,426.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,866.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,791.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,978.26
|
| Rate for Payer: Cash Price |
$1,076.70
|
| Rate for Payer: Cigna Commercial |
$3,433.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,088.80
|
| Rate for Payer: Health EOS Commercial |
$3,321.98
|
| Rate for Payer: HFN Commercial |
$3,433.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,799.42
|
| Rate for Payer: Multiplan Commercial |
$2,986.05
|
| Rate for Payer: NAPHCARE Commercial |
$2,239.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,433.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,828.95
|
| Rate for Payer: Quartz Commercial |
$2,426.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,239.54
|
| Rate for Payer: The Alliance Commercial |
$1,866.28
|
| Rate for Payer: WEA Trust Commercial |
$2,052.91
|
| Rate for Payer: WPS Commercial |
$2,764.61
|
|
|
FORCEP GRASPING DISP FG-54D
|
Facility
|
IP
|
$3,589.00
|
|
| Hospital Charge Code |
2973405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,828.95 |
| Max. Negotiated Rate |
$3,433.96 |
| Rate for Payer: Aetna Commercial |
$3,359.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,210.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,978.26
|
| Rate for Payer: Cash Price |
$1,076.70
|
| Rate for Payer: Cigna Commercial |
$3,433.96
|
| Rate for Payer: Health EOS Commercial |
$3,321.98
|
| Rate for Payer: HFN Commercial |
$3,433.96
|
| Rate for Payer: Multiplan Commercial |
$2,986.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,433.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,828.95
|
| Rate for Payer: Quartz Commercial |
$2,239.54
|
| Rate for Payer: WEA Trust Commercial |
$2,052.91
|
| Rate for Payer: WPS Commercial |
$2,764.61
|
|
|
FORCEPS BIOPSY DISPOSABLE
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2973654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
FORCEPS BIOPSY DISPOSABLE
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2973654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
FORCEP SHARK TOOTH CYSTOSCOPY DISP SINGLE USE FG-253SX
|
Facility
|
IP
|
$951.00
|
|
| Hospital Charge Code |
6178114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.63 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$593.42
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
FORCEP SHARK TOOTH CYSTOSCOPY DISP SINGLE USE FG-253SX
|
Facility
|
OP
|
$951.00
|
|
| Hospital Charge Code |
6178114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.93 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Aetna Managed Medicare |
$276.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$553.48
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.78
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: NAPHCARE Commercial |
$593.42
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$642.88
|
| Rate for Payer: Quartz Medicare Advantage |
$593.42
|
| Rate for Payer: The Alliance Commercial |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
Forceps - Individual Charges
|
Facility
|
IP
|
$641.00
|
|
| Hospital Charge Code |
3003919
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$326.65 |
| Max. Negotiated Rate |
$613.31 |
| Rate for Payer: Aetna Commercial |
$599.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.32
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$613.31
|
| Rate for Payer: Health EOS Commercial |
$593.31
|
| Rate for Payer: HFN Commercial |
$613.31
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: Preferred Network Access Commercial |
$613.31
|
| Rate for Payer: Quartz Beloit One Network |
$326.65
|
| Rate for Payer: Quartz Commercial |
$399.98
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$493.76
|
|
|
Forceps - Individual Charges
|
Facility
|
OP
|
$641.00
|
|
| Hospital Charge Code |
3003919
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$186.66 |
| Max. Negotiated Rate |
$613.31 |
| Rate for Payer: Aetna Commercial |
$599.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Aetna Managed Medicare |
$186.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$433.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.32
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$613.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.06
|
| Rate for Payer: Health EOS Commercial |
$593.31
|
| Rate for Payer: HFN Commercial |
$613.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$499.98
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: NAPHCARE Commercial |
$399.98
|
| Rate for Payer: Preferred Network Access Commercial |
$613.31
|
| Rate for Payer: Quartz Beloit One Network |
$326.65
|
| Rate for Payer: Quartz Commercial |
$433.32
|
| Rate for Payer: Quartz Medicare Advantage |
$399.98
|
| Rate for Payer: The Alliance Commercial |
$333.32
|
| Rate for Payer: United Healthcare PPO |
$499.98
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$493.76
|
|
|
FORCEP TRIPOD GRASPING 230cm
|
Facility
|
IP
|
$5,491.00
|
|
| Hospital Charge Code |
2973590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,798.21 |
| Max. Negotiated Rate |
$5,253.79 |
| Rate for Payer: Aetna Commercial |
$5,139.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,911.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,026.64
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cigna Commercial |
$5,253.79
|
| Rate for Payer: Health EOS Commercial |
$5,082.47
|
| Rate for Payer: HFN Commercial |
$5,253.79
|
| Rate for Payer: Multiplan Commercial |
$4,568.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,253.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,798.21
|
| Rate for Payer: Quartz Commercial |
$3,426.38
|
| Rate for Payer: WEA Trust Commercial |
$3,140.85
|
| Rate for Payer: WPS Commercial |
$4,229.72
|
|
|
FORCEP TRIPOD GRASPING 230cm
|
Facility
|
OP
|
$5,491.00
|
|
| Hospital Charge Code |
2973590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,598.98 |
| Max. Negotiated Rate |
$5,253.79 |
| Rate for Payer: Aetna Commercial |
$5,139.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,911.15
|
| Rate for Payer: Aetna Managed Medicare |
$1,598.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,711.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,855.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,741.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,026.64
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cigna Commercial |
$5,253.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,195.76
|
| Rate for Payer: Health EOS Commercial |
$5,082.47
|
| Rate for Payer: HFN Commercial |
$5,253.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,282.98
|
| Rate for Payer: Multiplan Commercial |
$4,568.51
|
| Rate for Payer: NAPHCARE Commercial |
$3,426.38
|
| Rate for Payer: Preferred Network Access Commercial |
$5,253.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,798.21
|
| Rate for Payer: Quartz Commercial |
$3,711.92
|
| Rate for Payer: Quartz Medicare Advantage |
$3,426.38
|
| Rate for Payer: The Alliance Commercial |
$2,855.32
|
| Rate for Payer: WEA Trust Commercial |
$3,140.85
|
| Rate for Payer: WPS Commercial |
$4,229.72
|
|
|
Forearm/arm cuffs free motio L3720
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
4253642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.57 |
| Max. Negotiated Rate |
$3,179.16 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,124.20
|
| Rate for Payer: Aetna Managed Medicare |
$691.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$301.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,309.10
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$2,272.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,382.25
|
| Rate for Payer: Health EOS Commercial |
$2,198.30
|
| Rate for Payer: HFN Commercial |
$2,272.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,852.50
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,482.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,272.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,210.30
|
| Rate for Payer: Quartz Commercial |
$1,605.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,482.00
|
| Rate for Payer: The Alliance Commercial |
$3,179.16
|
| Rate for Payer: WEA Trust Commercial |
$1,358.50
|
| Rate for Payer: WPS Commercial |
$1,829.46
|
|
|
Forearm/arm cuffs free motio L3720
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
4253642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$794.79 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Aetna Commercial |
$2,346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,124.20
|
| Rate for Payer: Aetna Managed Medicare |
$794.79
|
| Rate for Payer: Anthem Medicare Advantage |
$794.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.79
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$2,346.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,235.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$794.79
|
| Rate for Payer: Health EOS Commercial |
$2,247.70
|
| Rate for Payer: HFN Commercial |
$2,346.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,291.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,291.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.79
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,192.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.80
|
| Rate for Payer: Quartz Commercial |
$1,407.90
|
| Rate for Payer: Quartz Medicare Advantage |
$794.79
|
| Rate for Payer: The Alliance Commercial |
$2,185.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.79
|
| Rate for Payer: WEA Trust Commercial |
$1,358.50
|
| Rate for Payer: WPS Commercial |
$1,390.88
|
|
|
Forearm/arm cuffs free motio L3720
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
4253642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,210.30 |
| Max. Negotiated Rate |
$2,272.40 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,124.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,309.10
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$2,272.40
|
| Rate for Payer: Health EOS Commercial |
$2,198.30
|
| Rate for Payer: HFN Commercial |
$2,272.40
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,272.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,210.30
|
| Rate for Payer: Quartz Commercial |
$1,482.00
|
| Rate for Payer: WEA Trust Commercial |
$1,358.50
|
| Rate for Payer: WPS Commercial |
$1,829.46
|
|
