|
HAND ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960443
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,333.09 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Aetna Managed Medicare |
$2,333.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,416.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,166.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,662.98
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,249.36
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$5,416.11
|
| Rate for Payer: Quartz Medicare Advantage |
$4,999.49
|
| Rate for Payer: The Alliance Commercial |
$4,166.24
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
HAND ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960443
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,082.92 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$4,999.49
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
HAND BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959862
|
|
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
|
|
|
HAND BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959862
|
|
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
|
|
|
HAND CONTROL PROBE PLUS #EPH04
|
Facility
|
OP
|
$2,313.00
|
|
| Hospital Charge Code |
2962877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$673.55 |
| Max. Negotiated Rate |
$2,213.08 |
| Rate for Payer: Aetna Commercial |
$2,164.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,068.75
|
| Rate for Payer: Aetna Managed Medicare |
$673.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,563.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,202.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,154.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,274.93
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,213.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,346.17
|
| Rate for Payer: Health EOS Commercial |
$2,140.91
|
| Rate for Payer: HFN Commercial |
$2,213.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,804.14
|
| Rate for Payer: Multiplan Commercial |
$1,924.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,443.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,213.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,178.70
|
| Rate for Payer: Quartz Commercial |
$1,563.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,443.31
|
| Rate for Payer: The Alliance Commercial |
$1,202.76
|
| Rate for Payer: WEA Trust Commercial |
$1,323.04
|
| Rate for Payer: WPS Commercial |
$1,781.70
|
|
|
HAND CONTROL PROBE PLUS #EPH04
|
Facility
|
IP
|
$2,313.00
|
|
| Hospital Charge Code |
2962877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,178.70 |
| Max. Negotiated Rate |
$2,213.08 |
| Rate for Payer: Aetna Commercial |
$2,164.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,068.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,274.93
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,213.08
|
| Rate for Payer: Health EOS Commercial |
$2,140.91
|
| Rate for Payer: HFN Commercial |
$2,213.08
|
| Rate for Payer: Multiplan Commercial |
$1,924.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,213.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,178.70
|
| Rate for Payer: Quartz Commercial |
$1,443.31
|
| Rate for Payer: WEA Trust Commercial |
$1,323.04
|
| Rate for Payer: WPS Commercial |
$1,781.70
|
|
|
HAND CONTROL VAPR3 COOLPULSE 90 228147
|
Facility
|
IP
|
$4,257.00
|
|
| Hospital Charge Code |
3127483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,169.37 |
| Max. Negotiated Rate |
$4,073.10 |
| Rate for Payer: Aetna Commercial |
$3,984.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,807.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,346.46
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cigna Commercial |
$4,073.10
|
| Rate for Payer: Health EOS Commercial |
$3,940.28
|
| Rate for Payer: HFN Commercial |
$4,073.10
|
| Rate for Payer: Multiplan Commercial |
$3,541.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,073.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.37
|
| Rate for Payer: Quartz Commercial |
$2,656.37
|
| Rate for Payer: WEA Trust Commercial |
$2,435.00
|
| Rate for Payer: WPS Commercial |
$3,279.17
|
|
|
HAND CONTROL VAPR3 COOLPULSE 90 228147
|
Facility
|
OP
|
$4,257.00
|
|
| Hospital Charge Code |
3127483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,239.64 |
| Max. Negotiated Rate |
$4,073.10 |
| Rate for Payer: Aetna Commercial |
$3,984.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,807.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,877.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,125.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,346.46
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cigna Commercial |
$4,073.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,477.57
|
| Rate for Payer: Health EOS Commercial |
$3,940.28
|
| Rate for Payer: HFN Commercial |
$4,073.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,320.46
|
| Rate for Payer: Multiplan Commercial |
$3,541.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,073.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.37
|
| Rate for Payer: Quartz Commercial |
$2,877.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,656.37
|
| Rate for Payer: The Alliance Commercial |
$2,213.64
|
| Rate for Payer: WEA Trust Commercial |
$2,435.00
|
| Rate for Payer: WPS Commercial |
$3,279.17
|
|
|
HANDLE ZONE NAVIGATOR SYSTEM AR-7900
|
Facility
|
OP
|
$3,808.00
|
|
| Hospital Charge Code |
5599717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,108.89 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,574.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,980.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,900.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,216.26
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,970.24
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,574.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,376.19
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
HANDLE ZONE NAVIGATOR SYSTEM AR-7900
|
Facility
|
IP
|
$3,808.00
|
|
| Hospital Charge Code |
5599717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,940.56 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,376.19
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$45,152.64
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$12,563.09 |
| Max. Negotiated Rate |
$45,152.64 |
| Rate for Payer: Aetna Managed Medicare |
$12,563.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,349.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,328.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,014.24
|
| Rate for Payer: Anthem Medicare Advantage |
$12,563.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,563.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,563.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,563.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,768.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,563.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,873.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,563.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,563.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,563.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,563.09
|
| Rate for Payer: NAPHCARE Commercial |
$18,844.63
|
| Rate for Payer: Quartz Medicare Advantage |
$12,563.09
|
| Rate for Payer: The Alliance Commercial |
$45,152.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,563.09
|
| Rate for Payer: United Healthcare PPO |
$25,592.74
|
| Rate for Payer: Wellcare Medicare |
$12,563.09
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,130.40
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$8,335.77 |
| Max. Negotiated Rate |
$29,130.40 |
| Rate for Payer: Aetna Managed Medicare |
$8,335.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,305.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,097.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,243.45
|
| Rate for Payer: Anthem Medicare Advantage |
$8,335.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,335.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,335.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,335.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,031.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,335.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,121.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,335.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,335.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,335.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,335.77
|
| Rate for Payer: NAPHCARE Commercial |
$12,503.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8,335.77
|
| Rate for Payer: The Alliance Commercial |
$29,130.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,335.77
|
| Rate for Payer: United Healthcare PPO |
$16,443.45
|
| Rate for Payer: Wellcare Medicare |
$8,335.77
|
|
|
HAND OSTEOTOMY
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2960290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,503.16 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,065.09
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
HAND OSTEOTOMY
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2960290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,430.37 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,430.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,320.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,554.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,452.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,858.78
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,831.36
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,065.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,320.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,065.09
|
| Rate for Payer: The Alliance Commercial |
$2,554.24
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
HANDPIECE ABC 45DEG ANGLE FOOTSWITCHING (ARGON BEAM COAGULATOR) 130345
|
Facility
|
OP
|
$1,273.00
|
|
| Hospital Charge Code |
5415001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.70 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,191.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,138.57
|
| Rate for Payer: Aetna Managed Medicare |
$370.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$860.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$701.68
|
| Rate for Payer: Cash Price |
$381.90
|
| Rate for Payer: Cigna Commercial |
$1,218.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.89
|
| Rate for Payer: Health EOS Commercial |
$1,178.29
|
| Rate for Payer: HFN Commercial |
$1,218.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$992.94
|
| Rate for Payer: Multiplan Commercial |
$1,059.14
|
| Rate for Payer: NAPHCARE Commercial |
$794.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.01
|
| Rate for Payer: Quartz Beloit One Network |
$648.72
|
| Rate for Payer: Quartz Commercial |
$860.55
|
| Rate for Payer: Quartz Medicare Advantage |
$794.35
|
| Rate for Payer: The Alliance Commercial |
$661.96
|
| Rate for Payer: WEA Trust Commercial |
$728.16
|
| Rate for Payer: WPS Commercial |
$980.59
|
|
|
HANDPIECE ABC 45DEG ANGLE FOOTSWITCHING (ARGON BEAM COAGULATOR) 130345
|
Facility
|
IP
|
$1,273.00
|
|
| Hospital Charge Code |
5415001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$648.72 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,191.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,138.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$701.68
|
| Rate for Payer: Cash Price |
$381.90
|
| Rate for Payer: Cigna Commercial |
$1,218.01
|
| Rate for Payer: Health EOS Commercial |
$1,178.29
|
| Rate for Payer: HFN Commercial |
$1,218.01
|
| Rate for Payer: Multiplan Commercial |
$1,059.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.01
|
| Rate for Payer: Quartz Beloit One Network |
$648.72
|
| Rate for Payer: Quartz Commercial |
$794.35
|
| Rate for Payer: WEA Trust Commercial |
$728.16
|
| Rate for Payer: WPS Commercial |
$980.59
|
|
|
HANDPIECE I/A CAPSULEGUARD DISP 85910S
|
Facility
|
OP
|
$442.00
|
|
| Hospital Charge Code |
5415291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Aetna Managed Medicare |
$128.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$298.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.24
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.76
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$275.81
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$298.79
|
| Rate for Payer: Quartz Medicare Advantage |
$275.81
|
| Rate for Payer: The Alliance Commercial |
$229.84
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
HANDPIECE I/A CAPSULEGUARD DISP 85910S
|
Facility
|
IP
|
$442.00
|
|
| Hospital Charge Code |
5415291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$275.81
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
HANDPIECE MINERVA STERILE DISPOSABLE MIN9770
|
Facility
|
OP
|
$6,031.00
|
|
| Hospital Charge Code |
5415056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,756.23 |
| Max. Negotiated Rate |
$5,770.46 |
| Rate for Payer: Aetna Commercial |
$5,645.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,394.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,756.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,076.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,136.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,010.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,324.29
|
| Rate for Payer: Cash Price |
$1,809.30
|
| Rate for Payer: Cigna Commercial |
$5,770.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.04
|
| Rate for Payer: Health EOS Commercial |
$5,582.29
|
| Rate for Payer: HFN Commercial |
$5,770.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,704.18
|
| Rate for Payer: Multiplan Commercial |
$5,017.79
|
| Rate for Payer: NAPHCARE Commercial |
$3,763.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,770.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,073.40
|
| Rate for Payer: Quartz Commercial |
$4,076.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,763.34
|
| Rate for Payer: The Alliance Commercial |
$3,136.12
|
| Rate for Payer: WEA Trust Commercial |
$3,449.73
|
| Rate for Payer: WPS Commercial |
$4,645.68
|
|
|
HANDPIECE MINERVA STERILE DISPOSABLE MIN9770
|
Facility
|
IP
|
$6,031.00
|
|
| Hospital Charge Code |
5415056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,073.40 |
| Max. Negotiated Rate |
$5,770.46 |
| Rate for Payer: Aetna Commercial |
$5,645.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,394.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,324.29
|
| Rate for Payer: Cash Price |
$1,809.30
|
| Rate for Payer: Cigna Commercial |
$5,770.46
|
| Rate for Payer: Health EOS Commercial |
$5,582.29
|
| Rate for Payer: HFN Commercial |
$5,770.46
|
| Rate for Payer: Multiplan Commercial |
$5,017.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,770.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,073.40
|
| Rate for Payer: Quartz Commercial |
$3,763.34
|
| Rate for Payer: WEA Trust Commercial |
$3,449.73
|
| Rate for Payer: WPS Commercial |
$4,645.68
|
|
|
HAND PIECE OMNIGUIDE GYNE-LAP CURVED 10191
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
5563642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.81 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$507.94
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
HAND PIECE OMNIGUIDE GYNE-LAP CURVED 10191
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
5563642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.04 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Aetna Managed Medicare |
$237.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$550.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$423.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$406.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.75
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$634.92
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: NAPHCARE Commercial |
$507.94
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$550.26
|
| Rate for Payer: Quartz Medicare Advantage |
$507.94
|
| Rate for Payer: The Alliance Commercial |
$423.28
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
HANDPIECE THUNDERBEAT 5MM X 35CM FRONT-ACTUATED GRIP TB-0535FC
|
Facility
|
IP
|
$7,777.00
|
|
| Hospital Charge Code |
4595661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,963.16 |
| Max. Negotiated Rate |
$7,441.03 |
| Rate for Payer: Aetna Commercial |
$7,279.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,955.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,286.68
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,441.03
|
| Rate for Payer: Health EOS Commercial |
$7,198.39
|
| Rate for Payer: HFN Commercial |
$7,441.03
|
| Rate for Payer: Multiplan Commercial |
$6,470.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,441.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,963.16
|
| Rate for Payer: Quartz Commercial |
$4,852.85
|
| Rate for Payer: WEA Trust Commercial |
$4,448.44
|
| Rate for Payer: WPS Commercial |
$5,990.62
|
|
|
HANDPIECE THUNDERBEAT 5MM X 35CM FRONT-ACTUATED GRIP TB-0535FC
|
Facility
|
OP
|
$7,777.00
|
|
| Hospital Charge Code |
4595661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,264.66 |
| Max. Negotiated Rate |
$7,441.03 |
| Rate for Payer: Aetna Commercial |
$7,279.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,955.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,264.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,257.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,044.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,882.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,286.68
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,441.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,526.21
|
| Rate for Payer: Health EOS Commercial |
$7,198.39
|
| Rate for Payer: HFN Commercial |
$7,441.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,066.06
|
| Rate for Payer: Multiplan Commercial |
$6,470.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,852.85
|
| Rate for Payer: Preferred Network Access Commercial |
$7,441.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,963.16
|
| Rate for Payer: Quartz Commercial |
$5,257.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,852.85
|
| Rate for Payer: The Alliance Commercial |
$4,044.04
|
| Rate for Payer: WEA Trust Commercial |
$4,448.44
|
| Rate for Payer: WPS Commercial |
$5,990.62
|
|
|
HANDPIECE VERSAJET 52635
|
Facility
|
OP
|
$6,041.00
|
|
| Hospital Charge Code |
2966061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,759.14 |
| Max. Negotiated Rate |
$5,780.03 |
| Rate for Payer: Aetna Commercial |
$5,654.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,403.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,759.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,083.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,141.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,015.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,329.80
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,780.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,515.86
|
| Rate for Payer: Health EOS Commercial |
$5,591.55
|
| Rate for Payer: HFN Commercial |
$5,780.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,711.98
|
| Rate for Payer: Multiplan Commercial |
$5,026.11
|
| Rate for Payer: NAPHCARE Commercial |
$3,769.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,780.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,078.49
|
| Rate for Payer: Quartz Commercial |
$4,083.72
|
| Rate for Payer: Quartz Medicare Advantage |
$3,769.58
|
| Rate for Payer: The Alliance Commercial |
$3,141.32
|
| Rate for Payer: WEA Trust Commercial |
$3,455.45
|
| Rate for Payer: WPS Commercial |
$4,653.38
|
|
