|
GGT (FSURE)
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4538812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.42 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.40
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: HFN Commercial |
$79.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Giardia Ag
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
979859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Giardia Ag
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
979859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Giardia Ag
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
979859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.60
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Giardia and Cryptosporidium Antigen Panel
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5619633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Giardia and Cryptosporidium Antigen Panel
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5619633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Giardia and Cryptosporidium Antigen Panel
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5619633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.09
|
| Rate for Payer: Anthem Medicaid |
$5.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Dean Health Medicaid |
$5.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.25
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$26.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: Wellcare Medicare |
$6.68
|
| Rate for Payer: WMAP Medicaid |
$5.25
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
GI Tract Capsule Endoscopy 9111026
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
CPT 91110 26
|
| Hospital Charge Code |
3165592
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$437.61 |
| Max. Negotiated Rate |
$1,417.40 |
| Rate for Payer: Aetna Commercial |
$1,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.12
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$1,417.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$814.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.20
|
| Rate for Payer: Health EOS Commercial |
$1,357.72
|
| Rate for Payer: HFN Commercial |
$1,417.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.61
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.40
|
| Rate for Payer: Quartz Beloit One Network |
$656.48
|
| Rate for Payer: Quartz Commercial |
$850.44
|
| Rate for Payer: The Alliance Commercial |
$746.00
|
| Rate for Payer: United Healthcare Medicaid |
$814.60
|
| Rate for Payer: WEA Trust Commercial |
$820.60
|
| Rate for Payer: WPS Commercial |
$1,105.12
|
|
|
GLAUCOMA PROSTHETIC SHUNT
|
Facility
|
IP
|
$3,935.00
|
|
|
Service Code
|
CPT 66180
|
| Hospital Charge Code |
2960372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
GLAUCOMA PROSTHETIC SHUNT
|
Facility
|
OP
|
$3,935.00
|
|
|
Service Code
|
CPT 66180
|
| Hospital Charge Code |
2960372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$16,074.84 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,018.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,018.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,018.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,018.71
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,018.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,018.71
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,949.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,018.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,018.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,018.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,018.71
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,028.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,018.71
|
| Rate for Payer: The Alliance Commercial |
$16,074.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,018.71
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: Wellcare Medicare |
$4,018.71
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Glaucoma SCRN High Risk Direc G0118
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS G0118
|
| Hospital Charge Code |
4596650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.60
|
| Rate for Payer: Health EOS Commercial |
$123.76
|
| Rate for Payer: HFN Commercial |
$129.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.16
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$129.20
|
| Rate for Payer: Quartz Beloit One Network |
$59.84
|
| Rate for Payer: Quartz Commercial |
$77.52
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: United Healthcare Medicaid |
$34.98
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
GLENOID 44MM
|
Facility
|
OP
|
$6,804.00
|
|
| Hospital Charge Code |
3072417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$27,216.00 |
| Rate for Payer: Aetna Commercial |
$6,123.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,851.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,905.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,422.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,402.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,265.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,606.12
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,259.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,807.52
|
| Rate for Payer: Health EOS Commercial |
$6,055.56
|
| Rate for Payer: HFN Commercial |
$6,259.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,103.00
|
| Rate for Payer: Multiplan Commercial |
$5,443.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,082.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,259.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,333.96
|
| Rate for Payer: Quartz Commercial |
$4,422.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,082.40
|
| Rate for Payer: The Alliance Commercial |
$27,216.00
|
| Rate for Payer: WEA Trust Commercial |
$3,742.20
|
| Rate for Payer: WPS Commercial |
$5,039.72
|
|
|
GLENOID 44MM
|
Facility
|
IP
|
$6,804.00
|
|
| Hospital Charge Code |
3072417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,333.96 |
| Max. Negotiated Rate |
$6,259.68 |
| Rate for Payer: Aetna Commercial |
$6,123.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,851.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,606.12
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,259.68
|
| Rate for Payer: Health EOS Commercial |
$6,055.56
|
| Rate for Payer: HFN Commercial |
$6,259.68
|
| Rate for Payer: Multiplan Commercial |
$5,443.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,082.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,259.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,333.96
|
| Rate for Payer: Quartz Commercial |
$4,082.40
|
| Rate for Payer: WEA Trust Commercial |
$3,742.20
|
| Rate for Payer: WPS Commercial |
$5,039.72
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK LARGE 15L AR-9107-03-15L
|
Facility
|
IP
|
$15,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,409.78 |
| Max. Negotiated Rate |
$13,912.24 |
| Rate for Payer: Aetna Commercial |
$13,609.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,004.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,014.66
|
| Rate for Payer: Cash Price |
$4,536.60
|
| Rate for Payer: Cigna Commercial |
$13,912.24
|
| Rate for Payer: Health EOS Commercial |
$13,458.58
|
| Rate for Payer: HFN Commercial |
$13,912.24
|
| Rate for Payer: Multiplan Commercial |
$12,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,073.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,912.24
|
| Rate for Payer: Quartz Beloit One Network |
$7,409.78
|
| Rate for Payer: Quartz Commercial |
$9,073.20
|
| Rate for Payer: WEA Trust Commercial |
$8,317.10
|
| Rate for Payer: WPS Commercial |
$11,200.87
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK LARGE 15L AR-9107-03-15L
|
Facility
|
OP
|
$15,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,234.16 |
| Max. Negotiated Rate |
$60,488.00 |
| Rate for Payer: Aetna Commercial |
$13,609.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,004.92
|
| Rate for Payer: Aetna Managed Medicare |
$4,234.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,829.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,561.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,258.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,014.66
|
| Rate for Payer: Cash Price |
$4,536.60
|
| Rate for Payer: Cigna Commercial |
$13,912.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,462.27
|
| Rate for Payer: Health EOS Commercial |
$13,458.58
|
| Rate for Payer: HFN Commercial |
$13,912.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,341.50
|
| Rate for Payer: Multiplan Commercial |
$12,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,073.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,912.24
|
| Rate for Payer: Quartz Beloit One Network |
$7,409.78
|
| Rate for Payer: Quartz Commercial |
$9,829.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9,073.20
|
| Rate for Payer: The Alliance Commercial |
$60,488.00
|
| Rate for Payer: WEA Trust Commercial |
$8,317.10
|
| Rate for Payer: WPS Commercial |
$11,200.87
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK MEDIUM 15R AR-9107-02-15R
|
Facility
|
OP
|
$15,727.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5895636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,403.56 |
| Max. Negotiated Rate |
$62,908.00 |
| Rate for Payer: Aetna Commercial |
$14,154.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,525.22
|
| Rate for Payer: Aetna Managed Medicare |
$4,403.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,222.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,863.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,548.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,335.31
|
| Rate for Payer: Cash Price |
$4,718.10
|
| Rate for Payer: Cigna Commercial |
$14,468.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,800.83
|
| Rate for Payer: Health EOS Commercial |
$13,997.03
|
| Rate for Payer: HFN Commercial |
$14,468.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,795.25
|
| Rate for Payer: Multiplan Commercial |
$12,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,436.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,468.84
|
| Rate for Payer: Quartz Beloit One Network |
$7,706.23
|
| Rate for Payer: Quartz Commercial |
$10,222.55
|
| Rate for Payer: Quartz Medicare Advantage |
$9,436.20
|
| Rate for Payer: The Alliance Commercial |
$62,908.00
|
| Rate for Payer: WEA Trust Commercial |
$8,649.85
|
| Rate for Payer: WPS Commercial |
$11,648.99
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK MEDIUM 15R AR-9107-02-15R
|
Facility
|
IP
|
$15,727.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5895636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,706.23 |
| Max. Negotiated Rate |
$14,468.84 |
| Rate for Payer: Aetna Commercial |
$14,154.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,525.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,335.31
|
| Rate for Payer: Cash Price |
$4,718.10
|
| Rate for Payer: Cigna Commercial |
$14,468.84
|
| Rate for Payer: Health EOS Commercial |
$13,997.03
|
| Rate for Payer: HFN Commercial |
$14,468.84
|
| Rate for Payer: Multiplan Commercial |
$12,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,436.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,468.84
|
| Rate for Payer: Quartz Beloit One Network |
$7,706.23
|
| Rate for Payer: Quartz Commercial |
$9,436.20
|
| Rate for Payer: WEA Trust Commercial |
$8,649.85
|
| Rate for Payer: WPS Commercial |
$11,648.99
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK SMALL 15R AR-9107-01-15R
|
Facility
|
OP
|
$14,540.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.20 |
| Max. Negotiated Rate |
$58,160.00 |
| Rate for Payer: Aetna Commercial |
$13,086.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,504.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,071.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,451.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,270.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,979.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,706.20
|
| Rate for Payer: Cash Price |
$4,362.00
|
| Rate for Payer: Cigna Commercial |
$13,376.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,136.58
|
| Rate for Payer: Health EOS Commercial |
$12,940.60
|
| Rate for Payer: HFN Commercial |
$13,376.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,905.00
|
| Rate for Payer: Multiplan Commercial |
$11,632.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,376.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,124.60
|
| Rate for Payer: Quartz Commercial |
$9,451.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,724.00
|
| Rate for Payer: The Alliance Commercial |
$58,160.00
|
| Rate for Payer: WEA Trust Commercial |
$7,997.00
|
| Rate for Payer: WPS Commercial |
$10,769.78
|
|
|
GLENOID AUGMENTED UNIVERS VAULTLOCK SMALL 15R AR-9107-01-15R
|
Facility
|
IP
|
$14,540.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,124.60 |
| Max. Negotiated Rate |
$13,376.80 |
| Rate for Payer: Aetna Commercial |
$13,086.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,504.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,706.20
|
| Rate for Payer: Cash Price |
$4,362.00
|
| Rate for Payer: Cigna Commercial |
$13,376.80
|
| Rate for Payer: Health EOS Commercial |
$12,940.60
|
| Rate for Payer: HFN Commercial |
$13,376.80
|
| Rate for Payer: Multiplan Commercial |
$11,632.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,376.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,124.60
|
| Rate for Payer: Quartz Commercial |
$8,724.00
|
| Rate for Payer: WEA Trust Commercial |
$7,997.00
|
| Rate for Payer: WPS Commercial |
$10,769.78
|
|
|
GLENOID PLATE SUPERIOR AUGMENT 10 DEG EQUINOXE REVERSE SHOULDER 320-15-02
|
Facility
|
IP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,400.04 |
| Max. Negotiated Rate |
$8,261.30 |
| Rate for Payer: Aetna Commercial |
$8,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,722.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,759.23
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,261.30
|
| Rate for Payer: Health EOS Commercial |
$7,991.91
|
| Rate for Payer: HFN Commercial |
$8,261.30
|
| Rate for Payer: Multiplan Commercial |
$7,183.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,261.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,400.04
|
| Rate for Payer: Quartz Commercial |
$5,387.80
|
| Rate for Payer: WEA Trust Commercial |
$4,938.82
|
| Rate for Payer: WPS Commercial |
$6,651.24
|
|
|
GLENOID PLATE SUPERIOR AUGMENT 10 DEG EQUINOXE REVERSE SHOULDER 320-15-02
|
Facility
|
OP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,514.31 |
| Max. Negotiated Rate |
$35,918.68 |
| Rate for Payer: Aetna Commercial |
$8,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,722.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,514.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,836.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,489.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,759.23
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,261.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,025.02
|
| Rate for Payer: Health EOS Commercial |
$7,991.91
|
| Rate for Payer: HFN Commercial |
$8,261.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,734.75
|
| Rate for Payer: Multiplan Commercial |
$7,183.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,261.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,400.04
|
| Rate for Payer: Quartz Commercial |
$5,836.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,387.80
|
| Rate for Payer: The Alliance Commercial |
$35,918.68
|
| Rate for Payer: WEA Trust Commercial |
$4,938.82
|
| Rate for Payer: WPS Commercial |
$6,651.24
|
|
|
GLENOID PLATE SUPERIOR/POSTERIOR AUGMENT SMALL RT EQUINOXE REVERSE SHOULDER 320-35-08
|
Facility
|
OP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,514.31 |
| Max. Negotiated Rate |
$35,918.68 |
| Rate for Payer: Aetna Commercial |
$8,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,722.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,514.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,836.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,489.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,759.23
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,261.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,025.02
|
| Rate for Payer: Health EOS Commercial |
$7,991.91
|
| Rate for Payer: HFN Commercial |
$8,261.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,734.75
|
| Rate for Payer: Multiplan Commercial |
$7,183.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,261.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,400.04
|
| Rate for Payer: Quartz Commercial |
$5,836.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,387.80
|
| Rate for Payer: The Alliance Commercial |
$35,918.68
|
| Rate for Payer: WEA Trust Commercial |
$4,938.82
|
| Rate for Payer: WPS Commercial |
$6,651.24
|
|
|
GLENOID PLATE SUPERIOR/POSTERIOR AUGMENT SMALL RT EQUINOXE REVERSE SHOULDER 320-35-08
|
Facility
|
IP
|
$8,979.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,400.04 |
| Max. Negotiated Rate |
$8,261.30 |
| Rate for Payer: Aetna Commercial |
$8,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,722.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,759.23
|
| Rate for Payer: Cash Price |
$2,693.90
|
| Rate for Payer: Cigna Commercial |
$8,261.30
|
| Rate for Payer: Health EOS Commercial |
$7,991.91
|
| Rate for Payer: HFN Commercial |
$8,261.30
|
| Rate for Payer: Multiplan Commercial |
$7,183.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,261.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,400.04
|
| Rate for Payer: Quartz Commercial |
$5,387.80
|
| Rate for Payer: WEA Trust Commercial |
$4,938.82
|
| Rate for Payer: WPS Commercial |
$6,651.24
|
|
|
GLENOID REVERSE UNIVERSAL SZ 42 AR-9504L
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
GLENOID REVERSE UNIVERSAL SZ 42 AR-9504L
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
