|
HAMMER TOE IMPLANT TWO-STEP 4.5MM X 3.0MM X 8MM 204-30-108
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3713497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,459.98 |
| Max. Negotiated Rate |
$8,373.84 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,461.20
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
HAMMER TOE IMPLANT TWO-STEP 4.5MM X 3.0MM X 8MM 204-30-108
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3713497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,548.56 |
| Max. Negotiated Rate |
$36,408.00 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,548.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,916.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,093.48
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,826.50
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,916.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,461.20
|
| Rate for Payer: The Alliance Commercial |
$36,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
HAMMERTOE PRO-TOE VO SM 0DEG
|
Facility
|
IP
|
$5,995.00
|
|
| Hospital Charge Code |
3072449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,937.55 |
| Max. Negotiated Rate |
$5,515.40 |
| Rate for Payer: Aetna Commercial |
$5,395.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,155.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,177.35
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,515.40
|
| Rate for Payer: Health EOS Commercial |
$5,335.55
|
| Rate for Payer: HFN Commercial |
$5,515.40
|
| Rate for Payer: Multiplan Commercial |
$4,796.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,597.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,515.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,937.55
|
| Rate for Payer: Quartz Commercial |
$3,597.00
|
| Rate for Payer: WEA Trust Commercial |
$3,297.25
|
| Rate for Payer: WPS Commercial |
$4,440.50
|
|
|
HAMMERTOE PRO-TOE VO SM 0DEG
|
Facility
|
OP
|
$5,995.00
|
|
| Hospital Charge Code |
3072449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$23,980.00 |
| Rate for Payer: Aetna Commercial |
$5,395.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,155.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,678.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,896.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,997.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,877.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,177.35
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,515.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,354.80
|
| Rate for Payer: Health EOS Commercial |
$5,335.55
|
| Rate for Payer: HFN Commercial |
$5,515.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,496.25
|
| Rate for Payer: Multiplan Commercial |
$4,796.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,597.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,515.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,937.55
|
| Rate for Payer: Quartz Commercial |
$3,896.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,597.00
|
| Rate for Payer: The Alliance Commercial |
$23,980.00
|
| Rate for Payer: WEA Trust Commercial |
$3,297.25
|
| Rate for Payer: WPS Commercial |
$4,440.50
|
|
|
HAMMER TOE REPAIR
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
HAMMER TOE REPAIR
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
HAND ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960443
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,243.36 |
| Max. Negotiated Rate |
$32,048.00 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,243.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,207.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,006.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,845.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,483.52
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,009.00
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$5,207.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,807.20
|
| Rate for Payer: The Alliance Commercial |
$32,048.00
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
HAND ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960443
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,925.88 |
| Max. Negotiated Rate |
$7,371.04 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$4,807.20
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
HAND BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959862
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
HAND BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959862
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
HAND CONTROL PROBE PLUS #EPH04
|
Facility
|
IP
|
$2,313.00
|
|
| Hospital Charge Code |
2962877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,133.37 |
| Max. Negotiated Rate |
$2,127.96 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,989.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,225.89
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,127.96
|
| Rate for Payer: Health EOS Commercial |
$2,058.57
|
| Rate for Payer: HFN Commercial |
$2,127.96
|
| Rate for Payer: Multiplan Commercial |
$1,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,127.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,133.37
|
| Rate for Payer: Quartz Commercial |
$1,387.80
|
| Rate for Payer: WEA Trust Commercial |
$1,272.15
|
| Rate for Payer: WPS Commercial |
$1,713.24
|
|
|
HAND CONTROL PROBE PLUS #EPH04
|
Facility
|
OP
|
$2,313.00
|
|
| Hospital Charge Code |
2962877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.64 |
| Max. Negotiated Rate |
$9,252.00 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,989.18
|
| Rate for Payer: Aetna Managed Medicare |
$647.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,503.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,156.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,225.89
|
| Rate for Payer: Cash Price |
$693.90
|
| Rate for Payer: Cigna Commercial |
$2,127.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,294.35
|
| Rate for Payer: Health EOS Commercial |
$2,058.57
|
| Rate for Payer: HFN Commercial |
$2,127.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,734.75
|
| Rate for Payer: Multiplan Commercial |
$1,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,387.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,127.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,133.37
|
| Rate for Payer: Quartz Commercial |
$1,503.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,387.80
|
| Rate for Payer: The Alliance Commercial |
$9,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,272.15
|
| Rate for Payer: WPS Commercial |
$1,713.24
|
|
|
HAND CONTROL VAPR3 COOLPULSE 90 228147
|
Facility
|
IP
|
$4,257.00
|
|
| Hospital Charge Code |
3127483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,085.93 |
| Max. Negotiated Rate |
$3,916.44 |
| Rate for Payer: Aetna Commercial |
$3,831.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,661.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,256.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cigna Commercial |
$3,916.44
|
| Rate for Payer: Health EOS Commercial |
$3,788.73
|
| Rate for Payer: HFN Commercial |
$3,916.44
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,554.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,916.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.93
|
| Rate for Payer: Quartz Commercial |
$2,554.20
|
| Rate for Payer: WEA Trust Commercial |
$2,341.35
|
| Rate for Payer: WPS Commercial |
$3,153.16
|
|
|
HAND CONTROL VAPR3 COOLPULSE 90 228147
|
Facility
|
OP
|
$4,257.00
|
|
| Hospital Charge Code |
3127483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.96 |
| Max. Negotiated Rate |
$17,028.00 |
| Rate for Payer: Aetna Commercial |
$3,831.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,661.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,767.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,128.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,043.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,256.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cigna Commercial |
$3,916.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,382.22
|
| Rate for Payer: Health EOS Commercial |
$3,788.73
|
| Rate for Payer: HFN Commercial |
$3,916.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,192.75
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,554.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,916.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.93
|
| Rate for Payer: Quartz Commercial |
$2,767.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,554.20
|
| Rate for Payer: The Alliance Commercial |
$17,028.00
|
| Rate for Payer: WEA Trust Commercial |
$2,341.35
|
| Rate for Payer: WPS Commercial |
$3,153.16
|
|
|
HANDLE ZONE NAVIGATOR SYSTEM AR-7900
|
Facility
|
IP
|
$3,808.00
|
|
| Hospital Charge Code |
5599717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,865.92 |
| Max. Negotiated Rate |
$3,503.36 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,284.80
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
HANDLE ZONE NAVIGATOR SYSTEM AR-7900
|
Facility
|
OP
|
$3,808.00
|
|
| Hospital Charge Code |
5599717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$15,232.00 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,066.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,475.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,904.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,827.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,130.96
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,475.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,284.80
|
| Rate for Payer: The Alliance Commercial |
$15,232.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$43,416.00
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$15,617.37 |
| Max. Negotiated Rate |
$43,416.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,617.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,987.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,051.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,750.36
|
| Rate for Payer: Anthem Medicare Advantage |
$15,617.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,617.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,617.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,617.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,475.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,617.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,609.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,617.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,617.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,617.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,617.37
|
| Rate for Payer: NAPHCARE Commercial |
$23,426.06
|
| Rate for Payer: Quartz Medicare Advantage |
$15,617.37
|
| Rate for Payer: The Alliance Commercial |
$43,416.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,617.37
|
| Rate for Payer: United Healthcare PPO |
$24,608.40
|
| Rate for Payer: Wellcare Medicare |
$15,617.37
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,010.00
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$10,075.43 |
| Max. Negotiated Rate |
$28,010.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,075.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,819.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$10,075.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,075.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,075.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,075.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,638.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,075.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,309.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,075.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,075.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,075.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,075.43
|
| Rate for Payer: NAPHCARE Commercial |
$15,113.14
|
| Rate for Payer: Quartz Medicare Advantage |
$10,075.43
|
| Rate for Payer: The Alliance Commercial |
$28,010.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,075.43
|
| Rate for Payer: United Healthcare PPO |
$15,811.01
|
| Rate for Payer: Wellcare Medicare |
$10,075.43
|
|
|
HAND OSTEOTOMY
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2960290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,406.88 |
| Max. Negotiated Rate |
$4,519.04 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$2,947.20
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
HAND OSTEOTOMY
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2960290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.36 |
| Max. Negotiated Rate |
$19,648.00 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,192.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.76
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,684.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$3,192.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,947.20
|
| Rate for Payer: The Alliance Commercial |
$19,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
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 |
$623.77 |
| Max. Negotiated Rate |
$1,171.16 |
| Rate for Payer: Aetna Commercial |
$1,145.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,094.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$674.69
|
| Rate for Payer: Cash Price |
$381.90
|
| Rate for Payer: Cigna Commercial |
$1,171.16
|
| Rate for Payer: Health EOS Commercial |
$1,132.97
|
| Rate for Payer: HFN Commercial |
$1,171.16
|
| Rate for Payer: Multiplan Commercial |
$1,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$763.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,171.16
|
| Rate for Payer: Quartz Beloit One Network |
$623.77
|
| Rate for Payer: Quartz Commercial |
$763.80
|
| Rate for Payer: WEA Trust Commercial |
$700.15
|
| Rate for Payer: WPS Commercial |
$942.91
|
|
|
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 |
$356.44 |
| Max. Negotiated Rate |
$5,092.00 |
| Rate for Payer: Aetna Commercial |
$1,145.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,094.78
|
| Rate for Payer: Aetna Managed Medicare |
$356.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$827.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$636.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$611.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$674.69
|
| Rate for Payer: Cash Price |
$381.90
|
| Rate for Payer: Cigna Commercial |
$1,171.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$712.37
|
| Rate for Payer: Health EOS Commercial |
$1,132.97
|
| Rate for Payer: HFN Commercial |
$1,171.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$954.75
|
| Rate for Payer: Multiplan Commercial |
$1,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$763.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,171.16
|
| Rate for Payer: Quartz Beloit One Network |
$623.77
|
| Rate for Payer: Quartz Commercial |
$827.45
|
| Rate for Payer: Quartz Medicare Advantage |
$763.80
|
| Rate for Payer: The Alliance Commercial |
$5,092.00
|
| Rate for Payer: WEA Trust Commercial |
$700.15
|
| Rate for Payer: WPS Commercial |
$942.91
|
|
|
HANDPIECE I/A CAPSULEGUARD DISP 85910S
|
Facility
|
IP
|
$442.00
|
|
| Hospital Charge Code |
5415291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
HANDPIECE I/A CAPSULEGUARD DISP 85910S
|
Facility
|
OP
|
$442.00
|
|
| Hospital Charge Code |
5415291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$1,768.00 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$123.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.34
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.50
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$265.20
|
| Rate for Payer: The Alliance Commercial |
$1,768.00
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
HANDPIECE MINERVA STERILE DISPOSABLE MIN9770
|
Facility
|
OP
|
$6,031.00
|
|
| Hospital Charge Code |
5415056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,688.68 |
| Max. Negotiated Rate |
$24,124.00 |
| Rate for Payer: Aetna Commercial |
$5,427.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,688.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,920.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,894.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.43
|
| Rate for Payer: Cash Price |
$1,809.30
|
| Rate for Payer: Cigna Commercial |
$5,548.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,374.95
|
| Rate for Payer: Health EOS Commercial |
$5,367.59
|
| Rate for Payer: HFN Commercial |
$5,548.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,523.25
|
| Rate for Payer: Multiplan Commercial |
$4,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.19
|
| Rate for Payer: Quartz Commercial |
$3,920.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,618.60
|
| Rate for Payer: The Alliance Commercial |
$24,124.00
|
| Rate for Payer: WEA Trust Commercial |
$3,317.05
|
| Rate for Payer: WPS Commercial |
$4,467.16
|
|
