|
INSERT AS TIBIAL BEARING DCM ARCOM VANGUARD 12MM X 71MM 189062
|
Facility
|
OP
|
$5,053.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.84 |
| Max. Negotiated Rate |
$20,212.00 |
| Rate for Payer: Aetna Commercial |
$4,547.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,345.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,284.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,526.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,425.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.09
|
| Rate for Payer: Cash Price |
$1,515.90
|
| Rate for Payer: Cigna Commercial |
$4,648.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,827.66
|
| Rate for Payer: Health EOS Commercial |
$4,497.17
|
| Rate for Payer: HFN Commercial |
$4,648.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,789.75
|
| Rate for Payer: Multiplan Commercial |
$4,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,648.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.97
|
| Rate for Payer: Quartz Commercial |
$3,284.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,031.80
|
| Rate for Payer: The Alliance Commercial |
$20,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,779.15
|
| Rate for Payer: WPS Commercial |
$3,742.76
|
|
|
Insert Bladder Cath 51703
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
3137481
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.53 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.55
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: United Healthcare Medicaid |
$140.53
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Insert Bladder Catheter 5170150
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 51701 50
|
| Hospital Charge Code |
3970701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$640.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$579.64
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$640.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.40
|
| Rate for Payer: Health EOS Commercial |
$613.34
|
| Rate for Payer: HFN Commercial |
$640.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.65
|
| Rate for Payer: Multiplan Commercial |
$539.20
|
| Rate for Payer: Preferred Network Access Commercial |
$640.30
|
| Rate for Payer: Quartz Beloit One Network |
$296.56
|
| Rate for Payer: Quartz Commercial |
$384.18
|
| Rate for Payer: The Alliance Commercial |
$337.00
|
| Rate for Payer: United Healthcare Medicaid |
$57.49
|
| Rate for Payer: WEA Trust Commercial |
$370.70
|
| Rate for Payer: WPS Commercial |
$499.23
|
|
|
Insert Bladder Catheter 51701PP
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
3529570
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$305.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$293.02
|
| Rate for Payer: HFN Commercial |
$305.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.65
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$305.90
|
| Rate for Payer: Quartz Beloit One Network |
$141.68
|
| Rate for Payer: Quartz Commercial |
$183.54
|
| Rate for Payer: The Alliance Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicaid |
$57.49
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
INSERT CERAMIC NEUTRAL 52MM 36MM 1218-87-652
|
Facility
|
IP
|
$14,361.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,036.89 |
| Max. Negotiated Rate |
$13,212.12 |
| Rate for Payer: Aetna Commercial |
$12,924.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,350.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,611.33
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cigna Commercial |
$13,212.12
|
| Rate for Payer: Health EOS Commercial |
$12,781.29
|
| Rate for Payer: HFN Commercial |
$13,212.12
|
| Rate for Payer: Multiplan Commercial |
$11,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,616.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,212.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,036.89
|
| Rate for Payer: Quartz Commercial |
$8,616.60
|
| Rate for Payer: WEA Trust Commercial |
$7,898.55
|
| Rate for Payer: WPS Commercial |
$10,637.19
|
|
|
INSERT CERAMIC NEUTRAL 52MM 36MM 1218-87-652
|
Facility
|
OP
|
$14,361.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,021.08 |
| Max. Negotiated Rate |
$57,444.00 |
| Rate for Payer: Aetna Commercial |
$12,924.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,350.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,021.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,334.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,180.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,893.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,611.33
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cigna Commercial |
$13,212.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,036.42
|
| Rate for Payer: Health EOS Commercial |
$12,781.29
|
| Rate for Payer: HFN Commercial |
$13,212.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,770.75
|
| Rate for Payer: Multiplan Commercial |
$11,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,616.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,212.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,036.89
|
| Rate for Payer: Quartz Commercial |
$9,334.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8,616.60
|
| Rate for Payer: The Alliance Commercial |
$57,444.00
|
| Rate for Payer: WEA Trust Commercial |
$7,898.55
|
| Rate for Payer: WPS Commercial |
$10,637.19
|
|
|
INSERT COMPREHENSIVE REVERSE SHOULDER VIVACIT-E POLYETHYLENE BEARING +3 36MM 110031426
|
Facility
|
OP
|
$8,759.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,452.52 |
| Max. Negotiated Rate |
$35,036.00 |
| Rate for Payer: Aetna Commercial |
$7,883.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,532.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,452.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,693.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,379.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,204.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,642.27
|
| Rate for Payer: Cash Price |
$2,627.70
|
| Rate for Payer: Cigna Commercial |
$8,058.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,901.54
|
| Rate for Payer: Health EOS Commercial |
$7,795.51
|
| Rate for Payer: HFN Commercial |
$8,058.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,569.25
|
| Rate for Payer: Multiplan Commercial |
$7,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,255.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,058.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,291.91
|
| Rate for Payer: Quartz Commercial |
$5,693.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,255.40
|
| Rate for Payer: The Alliance Commercial |
$35,036.00
|
| Rate for Payer: WEA Trust Commercial |
$4,817.45
|
| Rate for Payer: WPS Commercial |
$6,487.79
|
|
|
INSERT COMPREHENSIVE REVERSE SHOULDER VIVACIT-E POLYETHYLENE BEARING +3 36MM 110031426
|
Facility
|
IP
|
$8,759.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,291.91 |
| Max. Negotiated Rate |
$8,058.28 |
| Rate for Payer: Aetna Commercial |
$7,883.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,532.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,642.27
|
| Rate for Payer: Cash Price |
$2,627.70
|
| Rate for Payer: Cigna Commercial |
$8,058.28
|
| Rate for Payer: Health EOS Commercial |
$7,795.51
|
| Rate for Payer: HFN Commercial |
$8,058.28
|
| Rate for Payer: Multiplan Commercial |
$7,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,255.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,058.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,291.91
|
| Rate for Payer: Quartz Commercial |
$5,255.40
|
| Rate for Payer: WEA Trust Commercial |
$4,817.45
|
| Rate for Payer: WPS Commercial |
$6,487.79
|
|
|
Inserted - Chest Tube Activity:
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$1,389.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$772.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$741.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$818.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$1,420.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$1,374.16
|
| Rate for Payer: HFN Commercial |
$1,420.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,420.48
|
| Rate for Payer: Quartz Beloit One Network |
$756.56
|
| Rate for Payer: Quartz Commercial |
$1,003.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$849.20
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,143.64
|
|
|
Inserted - Chest Tube Activity:
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$756.56 |
| Max. Negotiated Rate |
$1,420.48 |
| Rate for Payer: Aetna Commercial |
$1,389.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$818.32
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$1,420.48
|
| Rate for Payer: Health EOS Commercial |
$1,374.16
|
| Rate for Payer: HFN Commercial |
$1,420.48
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,420.48
|
| Rate for Payer: Quartz Beloit One Network |
$756.56
|
| Rate for Payer: Quartz Commercial |
$926.40
|
| Rate for Payer: WEA Trust Commercial |
$849.20
|
| Rate for Payer: WPS Commercial |
$1,143.64
|
|
|
Inserted - Enteral Tube Activity
|
Facility
|
OP
|
$177.00
|
|
| Hospital Charge Code |
3000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$49.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$106.20
|
| Rate for Payer: The Alliance Commercial |
$708.00
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Inserted - Enteral Tube Activity
|
Facility
|
IP
|
$177.00
|
|
| Hospital Charge Code |
3000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
INSERTER COOK MEDICAL G55179
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4641053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$29.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$64.20
|
| Rate for Payer: The Alliance Commercial |
$428.00
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
INSERTER COOK MEDICAL G55179
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4641053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
INSERTER TIGHTROPE BUTTON AR-2262
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
INSERTER TIGHTROPE BUTTON AR-2262
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 61MM EVERGRIP61
|
Facility
|
IP
|
$666.00
|
|
| Hospital Charge Code |
5496808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$612.72 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.98
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$612.72
|
| Rate for Payer: Health EOS Commercial |
$592.74
|
| Rate for Payer: HFN Commercial |
$612.72
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: NAPHCARE Commercial |
$399.60
|
| Rate for Payer: Preferred Network Access Commercial |
$612.72
|
| Rate for Payer: Quartz Beloit One Network |
$326.34
|
| Rate for Payer: Quartz Commercial |
$399.60
|
| Rate for Payer: WEA Trust Commercial |
$366.30
|
| Rate for Payer: WPS Commercial |
$493.31
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 61MM EVERGRIP61
|
Facility
|
OP
|
$666.00
|
|
| Hospital Charge Code |
5496808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.76
|
| Rate for Payer: Aetna Managed Medicare |
$186.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.98
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$612.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.69
|
| Rate for Payer: Health EOS Commercial |
$592.74
|
| Rate for Payer: HFN Commercial |
$612.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$499.50
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: NAPHCARE Commercial |
$399.60
|
| Rate for Payer: Preferred Network Access Commercial |
$612.72
|
| Rate for Payer: Quartz Beloit One Network |
$326.34
|
| Rate for Payer: Quartz Commercial |
$432.90
|
| Rate for Payer: Quartz Medicare Advantage |
$399.60
|
| Rate for Payer: The Alliance Commercial |
$2,664.00
|
| Rate for Payer: WEA Trust Commercial |
$366.30
|
| Rate for Payer: WPS Commercial |
$493.31
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 86MM EVERGRIP86
|
Facility
|
IP
|
$666.00
|
|
| Hospital Charge Code |
5520745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$612.72 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.98
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$612.72
|
| Rate for Payer: Health EOS Commercial |
$592.74
|
| Rate for Payer: HFN Commercial |
$612.72
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: NAPHCARE Commercial |
$399.60
|
| Rate for Payer: Preferred Network Access Commercial |
$612.72
|
| Rate for Payer: Quartz Beloit One Network |
$326.34
|
| Rate for Payer: Quartz Commercial |
$399.60
|
| Rate for Payer: WEA Trust Commercial |
$366.30
|
| Rate for Payer: WPS Commercial |
$493.31
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 86MM EVERGRIP86
|
Facility
|
OP
|
$666.00
|
|
| Hospital Charge Code |
5520745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.76
|
| Rate for Payer: Aetna Managed Medicare |
$186.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.98
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$612.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.69
|
| Rate for Payer: Health EOS Commercial |
$592.74
|
| Rate for Payer: HFN Commercial |
$612.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$499.50
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: NAPHCARE Commercial |
$399.60
|
| Rate for Payer: Preferred Network Access Commercial |
$612.72
|
| Rate for Payer: Quartz Beloit One Network |
$326.34
|
| Rate for Payer: Quartz Commercial |
$432.90
|
| Rate for Payer: Quartz Medicare Advantage |
$399.60
|
| Rate for Payer: The Alliance Commercial |
$2,664.00
|
| Rate for Payer: WEA Trust Commercial |
$366.30
|
| Rate for Payer: WPS Commercial |
$493.31
|
|
|
Insertion Femoral Artery
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3101787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.41 |
| Max. Negotiated Rate |
$1,204.28 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$785.40
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
Insertion Femoral Artery
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3101787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$5,236.00 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Aetna Managed Medicare |
$366.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.52
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.75
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$850.85
|
| Rate for Payer: Quartz Medicare Advantage |
$785.40
|
| Rate for Payer: The Alliance Commercial |
$5,236.00
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
Insertion Femor Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.40 |
| Max. Negotiated Rate |
$5,420.00 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Aetna Managed Medicare |
$379.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.26
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.25
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$880.75
|
| Rate for Payer: Quartz Medicare Advantage |
$813.00
|
| Rate for Payer: The Alliance Commercial |
$5,420.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
Insertion Femor Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.95 |
| Max. Negotiated Rate |
$1,246.60 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$813.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
INSERTION GUIDE SYNTH 323.050
|
Facility
|
OP
|
$7,633.00
|
|
| Hospital Charge Code |
2966609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,137.24 |
| Max. Negotiated Rate |
$30,532.00 |
| Rate for Payer: Aetna Commercial |
$6,869.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,137.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,961.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,816.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,663.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.49
|
| Rate for Payer: Cash Price |
$2,289.90
|
| Rate for Payer: Cigna Commercial |
$7,022.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,271.43
|
| Rate for Payer: Health EOS Commercial |
$6,793.37
|
| Rate for Payer: HFN Commercial |
$7,022.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,724.75
|
| Rate for Payer: Multiplan Commercial |
$6,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,579.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,022.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,740.17
|
| Rate for Payer: Quartz Commercial |
$4,961.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,579.80
|
| Rate for Payer: The Alliance Commercial |
$30,532.00
|
| Rate for Payer: WEA Trust Commercial |
$4,198.15
|
| Rate for Payer: WPS Commercial |
$5,653.76
|
|
