|
GYNECOLOGIC PREVENTIVE MEDICINE
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00878
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
|
H20/CO2 Cystometrogram Compl
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
3005553
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$593.17 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$726.34
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
H20/CO2 Cystometrogram Compl
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
3005553
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$786.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.07
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$786.86
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
Haemophilus influenza Type B Antibody IgG
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86684
|
| Hospital Charge Code |
1124802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$16.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.35
|
| Rate for Payer: Anthem Medicare Advantage |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.47
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.47
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.47
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$24.71
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$16.47
|
| Rate for Payer: The Alliance Commercial |
$65.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.47
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$16.47
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Haemophilus influenza Type B Antibody IgG
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86684
|
| Hospital Charge Code |
1124802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Haemophilus influenza Type B Antibody IgG
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86684
|
| Hospital Charge Code |
1124802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$16.47
|
| Rate for Payer: Anthem Medicare Advantage |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.47
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.47
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.47
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$24.71
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$16.47
|
| Rate for Payer: The Alliance Commercial |
$65.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.47
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$72.48
|
|
|
Haemophilus MIC - Kirby Bauer
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
1562856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$144.25 |
| Rate for Payer: Aetna Commercial |
$144.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$144.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$138.17
|
| Rate for Payer: HFN Commercial |
$144.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$144.25
|
| Rate for Payer: Quartz Beloit One Network |
$66.81
|
| Rate for Payer: Quartz Commercial |
$86.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Haemophilus MIC - Kirby Bauer
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
1562856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
Haemophilus MIC - Kirby Bauer
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
1562856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$113.88
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
HAGLUND/HEEL DEFORMITY, RESECTION
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
HAGLUND/HEEL DEFORMITY, RESECTION
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 10MM 5546-A-101
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5240747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 10MM 5546-A-101
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5240747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 5MM 5546-A-102
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5240745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 5MM 5546-A-102
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5240745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 10MM 5546-A-201
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5264614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 10MM 5546-A-201
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5264614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 5MM 5546-A-202
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5074736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 5MM 5546-A-202
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5074736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 10MM 5546-A-301
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5286730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 10MM 5546-A-301
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5286730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 5MM 5546-A-302
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5286731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 5MM 5546-A-302
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5286731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 4 10MM 5546-A-401
|
Facility
|
IP
|
$6,089.00
|
|
| Hospital Charge Code |
5286733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,102.95 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$3,799.54
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 4 10MM 5546-A-401
|
Facility
|
OP
|
$6,089.00
|
|
| Hospital Charge Code |
5286733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.12 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,039.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,543.80
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,749.42
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: NAPHCARE Commercial |
$3,799.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$4,116.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,799.54
|
| Rate for Payer: The Alliance Commercial |
$3,166.28
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
