|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT MEDIAL LG 5MM 159584
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4998678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.45 |
| Max. Negotiated Rate |
$5,156.60 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,363.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT MEDIAL LG 5MM 159584
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4998678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.40 |
| Max. Negotiated Rate |
$22,420.00 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,643.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,802.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,690.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,136.56
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,203.75
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,643.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.00
|
| Rate for Payer: The Alliance Commercial |
$22,420.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT SMALL 3MM 159568
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.40 |
| Max. Negotiated Rate |
$22,420.00 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,643.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,802.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,690.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,136.56
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,203.75
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,643.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.00
|
| Rate for Payer: The Alliance Commercial |
$22,420.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT SMALL 3MM 159568
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.45 |
| Max. Negotiated Rate |
$5,156.60 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,363.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT SMALL 4MM 159569
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5107210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.45 |
| Max. Negotiated Rate |
$5,156.60 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,363.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT SMALL 4MM 159569
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5107210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.40 |
| Max. Negotiated Rate |
$22,420.00 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,643.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,802.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,690.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,136.56
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,203.75
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,643.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.00
|
| Rate for Payer: The Alliance Commercial |
$22,420.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT SMALL 5MM 159570
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5307121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.45 |
| Max. Negotiated Rate |
$5,156.60 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,363.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
INSERT OXFORD ANATOMIC MENISCAL BEARING RT SMALL 5MM 159570
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5307121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.40 |
| Max. Negotiated Rate |
$22,420.00 |
| Rate for Payer: Aetna Commercial |
$5,044.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,820.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,643.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,802.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,690.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,970.65
|
| Rate for Payer: Cash Price |
$1,681.50
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,136.56
|
| Rate for Payer: Health EOS Commercial |
$4,988.45
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,203.75
|
| Rate for Payer: Multiplan Commercial |
$4,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.45
|
| Rate for Payer: Quartz Commercial |
$3,643.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.00
|
| Rate for Payer: The Alliance Commercial |
$22,420.00
|
| Rate for Payer: WEA Trust Commercial |
$3,082.75
|
| Rate for Payer: WPS Commercial |
$4,151.62
|
|
|
Insert Picc Cath 36568
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
3605579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$2,472.85 |
| Rate for Payer: Aetna Commercial |
$2,472.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,238.58
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,472.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.80
|
| Rate for Payer: Health EOS Commercial |
$2,368.73
|
| Rate for Payer: HFN Commercial |
$2,472.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.00
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.32
|
| Rate for Payer: Quartz Commercial |
$1,483.71
|
| Rate for Payer: The Alliance Commercial |
$1,301.50
|
| Rate for Payer: United Healthcare Medicaid |
$90.71
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
INSERT STANDARD SINGLE BLUE 10223B
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2962934
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.87
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
INSERT STANDARD SINGLE BLUE 10223B
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2962934
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
INSERT STEALTH FIBRA CLAMP A0G13
|
Facility
|
OP
|
$503.00
|
|
| Hospital Charge Code |
2964643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$2,012.00 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$140.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.48
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.25
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Quartz Medicare Advantage |
$301.80
|
| Rate for Payer: The Alliance Commercial |
$2,012.00
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
INSERT STEALTH FIBRA CLAMP A0G13
|
Facility
|
IP
|
$503.00
|
|
| Hospital Charge Code |
2964643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
INSERT SZ 3-4 13MM ARTICULAR 71453213
|
Facility
|
IP
|
$18,548.00
|
|
| Hospital Charge Code |
3072432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,088.52 |
| Max. Negotiated Rate |
$17,064.16 |
| Rate for Payer: Aetna Commercial |
$16,693.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,951.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,830.44
|
| Rate for Payer: Cash Price |
$5,564.40
|
| Rate for Payer: Cigna Commercial |
$17,064.16
|
| Rate for Payer: Health EOS Commercial |
$16,507.72
|
| Rate for Payer: HFN Commercial |
$17,064.16
|
| Rate for Payer: Multiplan Commercial |
$14,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,128.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,064.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,088.52
|
| Rate for Payer: Quartz Commercial |
$11,128.80
|
| Rate for Payer: WEA Trust Commercial |
$10,201.40
|
| Rate for Payer: WPS Commercial |
$13,738.50
|
|
|
INSERT SZ 3-4 13MM ARTICULAR 71453213
|
Facility
|
OP
|
$18,548.00
|
|
| Hospital Charge Code |
3072432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,193.44 |
| Max. Negotiated Rate |
$74,192.00 |
| Rate for Payer: Aetna Commercial |
$16,693.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,951.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,193.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,056.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,274.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,903.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,830.44
|
| Rate for Payer: Cash Price |
$5,564.40
|
| Rate for Payer: Cigna Commercial |
$17,064.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,379.46
|
| Rate for Payer: Health EOS Commercial |
$16,507.72
|
| Rate for Payer: HFN Commercial |
$17,064.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,911.00
|
| Rate for Payer: Multiplan Commercial |
$14,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,128.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,064.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,088.52
|
| Rate for Payer: Quartz Commercial |
$12,056.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11,128.80
|
| Rate for Payer: The Alliance Commercial |
$74,192.00
|
| Rate for Payer: WEA Trust Commercial |
$10,201.40
|
| Rate for Payer: WPS Commercial |
$13,738.50
|
|
|
Insert Temp Bladder Cath 5170222
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
CPT 51702 22
|
| Hospital Charge Code |
5360689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.20
|
| Rate for Payer: Health EOS Commercial |
$324.87
|
| Rate for Payer: HFN Commercial |
$339.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.30
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$339.15
|
| Rate for Payer: Quartz Beloit One Network |
$157.08
|
| Rate for Payer: Quartz Commercial |
$203.49
|
| Rate for Payer: The Alliance Commercial |
$178.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.76
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Insert Temp Bladder Cath 51702PP
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3241487
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna Commercial |
$282.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$282.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.20
|
| Rate for Payer: Health EOS Commercial |
$270.27
|
| Rate for Payer: HFN Commercial |
$282.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.30
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$282.15
|
| Rate for Payer: Quartz Beloit One Network |
$130.68
|
| Rate for Payer: Quartz Commercial |
$169.29
|
| Rate for Payer: The Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.76
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Insert Temp Urinary Catheter 51702
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5516936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.72
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$415.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
Insert Temp Urinary Catheter 51702
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5516936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$587.88 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$383.40
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
INSERT TIBIAL CR SZ 2 9MM
|
Facility
|
OP
|
$8,238.00
|
|
| Hospital Charge Code |
3072399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.64 |
| Max. Negotiated Rate |
$32,952.00 |
| Rate for Payer: Aetna Commercial |
$7,414.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,084.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,306.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,354.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,954.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.14
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,578.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,609.98
|
| Rate for Payer: Health EOS Commercial |
$7,331.82
|
| Rate for Payer: HFN Commercial |
$7,578.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,178.50
|
| Rate for Payer: Multiplan Commercial |
$6,590.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,942.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,578.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,036.62
|
| Rate for Payer: Quartz Commercial |
$5,354.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,942.80
|
| Rate for Payer: The Alliance Commercial |
$32,952.00
|
| Rate for Payer: WEA Trust Commercial |
$4,530.90
|
| Rate for Payer: WPS Commercial |
$6,101.89
|
|
|
INSERT TIBIAL CR SZ 2 9MM
|
Facility
|
IP
|
$8,238.00
|
|
| Hospital Charge Code |
3072399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,036.62 |
| Max. Negotiated Rate |
$7,578.96 |
| Rate for Payer: Aetna Commercial |
$7,414.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,084.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.14
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,578.96
|
| Rate for Payer: Health EOS Commercial |
$7,331.82
|
| Rate for Payer: HFN Commercial |
$7,578.96
|
| Rate for Payer: Multiplan Commercial |
$6,590.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,942.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,578.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,036.62
|
| Rate for Payer: Quartz Commercial |
$4,942.80
|
| Rate for Payer: WEA Trust Commercial |
$4,530.90
|
| Rate for Payer: WPS Commercial |
$6,101.89
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 2 5537-G-213
|
Facility
|
IP
|
$13,724.00
|
|
| Hospital Charge Code |
5074726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,724.76 |
| Max. Negotiated Rate |
$12,626.08 |
| Rate for Payer: Aetna Commercial |
$12,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,802.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,273.72
|
| Rate for Payer: Cash Price |
$4,117.20
|
| Rate for Payer: Cigna Commercial |
$12,626.08
|
| Rate for Payer: Health EOS Commercial |
$12,214.36
|
| Rate for Payer: HFN Commercial |
$12,626.08
|
| Rate for Payer: Multiplan Commercial |
$10,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,626.08
|
| Rate for Payer: Quartz Beloit One Network |
$6,724.76
|
| Rate for Payer: Quartz Commercial |
$8,234.40
|
| Rate for Payer: WEA Trust Commercial |
$7,548.20
|
| Rate for Payer: WPS Commercial |
$10,165.37
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 2 5537-G-213
|
Facility
|
OP
|
$13,724.00
|
|
| Hospital Charge Code |
5074726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,842.72 |
| Max. Negotiated Rate |
$54,896.00 |
| Rate for Payer: Aetna Commercial |
$12,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,802.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,842.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,920.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,862.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,587.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,273.72
|
| Rate for Payer: Cash Price |
$4,117.20
|
| Rate for Payer: Cigna Commercial |
$12,626.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,679.95
|
| Rate for Payer: Health EOS Commercial |
$12,214.36
|
| Rate for Payer: HFN Commercial |
$12,626.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,293.00
|
| Rate for Payer: Multiplan Commercial |
$10,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,626.08
|
| Rate for Payer: Quartz Beloit One Network |
$6,724.76
|
| Rate for Payer: Quartz Commercial |
$8,920.60
|
| Rate for Payer: Quartz Medicare Advantage |
$8,234.40
|
| Rate for Payer: The Alliance Commercial |
$54,896.00
|
| Rate for Payer: WEA Trust Commercial |
$7,548.20
|
| Rate for Payer: WPS Commercial |
$10,165.37
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 3 13MM 5537-G-313-E
|
Facility
|
IP
|
$10,075.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,936.96 |
| Max. Negotiated Rate |
$9,269.39 |
| Rate for Payer: Aetna Commercial |
$9,067.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,664.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,339.97
|
| Rate for Payer: Cash Price |
$3,022.63
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: Health EOS Commercial |
$8,967.12
|
| Rate for Payer: HFN Commercial |
$9,269.39
|
| Rate for Payer: Multiplan Commercial |
$8,060.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,045.25
|
| Rate for Payer: Preferred Network Access Commercial |
$9,269.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,936.96
|
| Rate for Payer: Quartz Commercial |
$6,045.25
|
| Rate for Payer: WEA Trust Commercial |
$5,541.48
|
| Rate for Payer: WPS Commercial |
$7,462.86
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 3 13MM 5537-G-313-E
|
Facility
|
OP
|
$10,075.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,821.12 |
| Max. Negotiated Rate |
$40,301.68 |
| Rate for Payer: Aetna Commercial |
$9,067.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,664.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,821.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,549.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,037.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,836.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,339.97
|
| Rate for Payer: Cash Price |
$3,022.63
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,638.21
|
| Rate for Payer: Health EOS Commercial |
$8,967.12
|
| Rate for Payer: HFN Commercial |
$9,269.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,556.56
|
| Rate for Payer: Multiplan Commercial |
$8,060.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,045.25
|
| Rate for Payer: Preferred Network Access Commercial |
$9,269.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,936.96
|
| Rate for Payer: Quartz Commercial |
$6,549.02
|
| Rate for Payer: Quartz Medicare Advantage |
$6,045.25
|
| Rate for Payer: The Alliance Commercial |
$40,301.68
|
| Rate for Payer: WEA Trust Commercial |
$5,541.48
|
| Rate for Payer: WPS Commercial |
$7,462.86
|
|
