|
Insert Picc Cath 36568
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
3605579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$2,571.76 |
| Rate for Payer: Aetna Commercial |
$2,571.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.12
|
| Rate for Payer: Aetna Managed Medicare |
$80.66
|
| Rate for Payer: Anthem Medicare Advantage |
$80.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.66
|
| 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 |
$2,571.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.66
|
| Rate for Payer: Health EOS Commercial |
$2,463.48
|
| Rate for Payer: HFN Commercial |
$2,571.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$319.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.66
|
| Rate for Payer: Multiplan Commercial |
$2,165.70
|
| Rate for Payer: NAPHCARE Commercial |
$120.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,571.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.13
|
| Rate for Payer: Quartz Commercial |
$1,543.06
|
| Rate for Payer: Quartz Medicare Advantage |
$80.66
|
| Rate for Payer: The Alliance Commercial |
$342.82
|
| Rate for Payer: United Healthcare Medicaid |
$94.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.66
|
| Rate for Payer: WEA Trust Commercial |
$1,488.92
|
| Rate for Payer: WPS Commercial |
$362.98
|
|
|
INSERT STANDARD SINGLE BLUE 10223B
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2962934
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
INSERT STANDARD SINGLE BLUE 10223B
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2962934
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
INSERT STEALTH FIBRA CLAMP A0G13
|
Facility
|
IP
|
$503.00
|
|
| Hospital Charge Code |
2964643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$313.87
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
INSERT STEALTH FIBRA CLAMP A0G13
|
Facility
|
OP
|
$503.00
|
|
| Hospital Charge Code |
2964643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.47 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$146.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.34
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$313.87
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$340.03
|
| Rate for Payer: Quartz Medicare Advantage |
$313.87
|
| Rate for Payer: The Alliance Commercial |
$261.56
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
INSERT SZ 3-4 13MM ARTICULAR 71453213
|
Facility
|
IP
|
$18,548.00
|
|
| Hospital Charge Code |
3072432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,452.06 |
| Max. Negotiated Rate |
$17,746.73 |
| Rate for Payer: Aetna Commercial |
$17,360.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,589.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,223.66
|
| Rate for Payer: Cash Price |
$5,564.40
|
| Rate for Payer: Cigna Commercial |
$17,746.73
|
| Rate for Payer: Health EOS Commercial |
$17,168.03
|
| Rate for Payer: HFN Commercial |
$17,746.73
|
| Rate for Payer: Multiplan Commercial |
$15,431.94
|
| Rate for Payer: Preferred Network Access Commercial |
$17,746.73
|
| Rate for Payer: Quartz Beloit One Network |
$9,452.06
|
| Rate for Payer: Quartz Commercial |
$11,573.95
|
| Rate for Payer: WEA Trust Commercial |
$10,609.46
|
| Rate for Payer: WPS Commercial |
$14,287.52
|
|
|
INSERT SZ 3-4 13MM ARTICULAR 71453213
|
Facility
|
OP
|
$18,548.00
|
|
| Hospital Charge Code |
3072432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,401.18 |
| Max. Negotiated Rate |
$17,746.73 |
| Rate for Payer: Aetna Commercial |
$17,360.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,589.33
|
| Rate for Payer: Aetna Managed Medicare |
$5,401.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,538.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,644.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,259.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,223.66
|
| Rate for Payer: Cash Price |
$5,564.40
|
| Rate for Payer: Cigna Commercial |
$17,746.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,794.94
|
| Rate for Payer: Health EOS Commercial |
$17,168.03
|
| Rate for Payer: HFN Commercial |
$17,746.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,467.44
|
| Rate for Payer: Multiplan Commercial |
$15,431.94
|
| Rate for Payer: NAPHCARE Commercial |
$11,573.95
|
| Rate for Payer: Preferred Network Access Commercial |
$17,746.73
|
| Rate for Payer: Quartz Beloit One Network |
$9,452.06
|
| Rate for Payer: Quartz Commercial |
$12,538.45
|
| Rate for Payer: Quartz Medicare Advantage |
$11,573.95
|
| Rate for Payer: The Alliance Commercial |
$9,644.96
|
| Rate for Payer: WEA Trust Commercial |
$10,609.46
|
| Rate for Payer: WPS Commercial |
$14,287.52
|
|
|
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 |
$76.71 |
| Max. Negotiated Rate |
$352.72 |
| Rate for Payer: Aetna Commercial |
$352.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| 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 |
$352.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.77
|
| Rate for Payer: Health EOS Commercial |
$337.86
|
| Rate for Payer: HFN Commercial |
$352.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.67
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$352.72
|
| Rate for Payer: Quartz Beloit One Network |
$163.36
|
| Rate for Payer: Quartz Commercial |
$211.63
|
| Rate for Payer: The Alliance Commercial |
$185.64
|
| Rate for Payer: United Healthcare Medicaid |
$76.71
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Insert Temp Bladder Cath 51702PP
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3241487
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$293.44 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$21.77
|
| Rate for Payer: Anthem Medicare Advantage |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.77
|
| 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 |
$293.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.77
|
| Rate for Payer: Health EOS Commercial |
$281.08
|
| Rate for Payer: HFN Commercial |
$293.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.77
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$32.65
|
| Rate for Payer: Preferred Network Access Commercial |
$293.44
|
| Rate for Payer: Quartz Beloit One Network |
$135.91
|
| Rate for Payer: Quartz Commercial |
$176.06
|
| Rate for Payer: Quartz Medicare Advantage |
$21.77
|
| Rate for Payer: The Alliance Commercial |
$92.51
|
| Rate for Payer: United Healthcare Medicaid |
$76.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.77
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$97.95
|
|
|
Insert Temp Urinary Catheter 51702
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5516936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.99
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| 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 |
$611.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$431.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
Insert Temp Urinary Catheter 51702
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5516936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.63 |
| Max. Negotiated Rate |
$611.40 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$398.74
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
INSERT TIBIAL CR SZ 2 9MM
|
Facility
|
OP
|
$8,238.00
|
|
| Hospital Charge Code |
3072399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,398.91 |
| Max. Negotiated Rate |
$7,882.12 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,398.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,568.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,283.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,112.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,794.52
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,425.64
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: NAPHCARE Commercial |
$5,140.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,568.89
|
| Rate for Payer: Quartz Medicare Advantage |
$5,140.51
|
| Rate for Payer: The Alliance Commercial |
$4,283.76
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
INSERT TIBIAL CR SZ 2 9MM
|
Facility
|
IP
|
$8,238.00
|
|
| Hospital Charge Code |
3072399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.08 |
| Max. Negotiated Rate |
$7,882.12 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,140.51
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
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 |
$3,996.43 |
| Max. Negotiated Rate |
$13,131.12 |
| Rate for Payer: Aetna Commercial |
$12,845.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,274.75
|
| Rate for Payer: Aetna Managed Medicare |
$3,996.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,277.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,136.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,851.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,564.67
|
| Rate for Payer: Cash Price |
$4,117.20
|
| Rate for Payer: Cigna Commercial |
$13,131.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,987.37
|
| Rate for Payer: Health EOS Commercial |
$12,702.93
|
| Rate for Payer: HFN Commercial |
$13,131.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,704.72
|
| Rate for Payer: Multiplan Commercial |
$11,418.37
|
| Rate for Payer: NAPHCARE Commercial |
$8,563.78
|
| Rate for Payer: Preferred Network Access Commercial |
$13,131.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,993.75
|
| Rate for Payer: Quartz Commercial |
$9,277.42
|
| Rate for Payer: Quartz Medicare Advantage |
$8,563.78
|
| Rate for Payer: The Alliance Commercial |
$7,136.48
|
| Rate for Payer: WEA Trust Commercial |
$7,850.13
|
| Rate for Payer: WPS Commercial |
$10,571.60
|
|
|
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 |
$6,993.75 |
| Max. Negotiated Rate |
$13,131.12 |
| Rate for Payer: Aetna Commercial |
$12,845.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,274.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,564.67
|
| Rate for Payer: Cash Price |
$4,117.20
|
| Rate for Payer: Cigna Commercial |
$13,131.12
|
| Rate for Payer: Health EOS Commercial |
$12,702.93
|
| Rate for Payer: HFN Commercial |
$13,131.12
|
| Rate for Payer: Multiplan Commercial |
$11,418.37
|
| Rate for Payer: Preferred Network Access Commercial |
$13,131.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,993.75
|
| Rate for Payer: Quartz Commercial |
$8,563.78
|
| Rate for Payer: WEA Trust Commercial |
$7,850.13
|
| Rate for Payer: WPS Commercial |
$10,571.60
|
|
|
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 |
$5,134.43 |
| Max. Negotiated Rate |
$9,640.16 |
| Rate for Payer: Aetna Commercial |
$9,430.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,011.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,553.57
|
| Rate for Payer: Cash Price |
$3,022.63
|
| Rate for Payer: Cigna Commercial |
$9,640.16
|
| Rate for Payer: Health EOS Commercial |
$9,325.81
|
| Rate for Payer: HFN Commercial |
$9,640.16
|
| Rate for Payer: Multiplan Commercial |
$8,382.75
|
| Rate for Payer: Preferred Network Access Commercial |
$9,640.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,134.43
|
| Rate for Payer: Quartz Commercial |
$6,287.06
|
| Rate for Payer: WEA Trust Commercial |
$5,763.14
|
| Rate for Payer: WPS Commercial |
$7,761.10
|
|
|
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 |
$2,933.96 |
| Max. Negotiated Rate |
$9,640.16 |
| Rate for Payer: Aetna Commercial |
$9,430.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,011.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,933.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,810.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,239.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,029.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,553.57
|
| Rate for Payer: Cash Price |
$3,022.63
|
| Rate for Payer: Cigna Commercial |
$9,640.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,863.89
|
| Rate for Payer: Health EOS Commercial |
$9,325.81
|
| Rate for Payer: HFN Commercial |
$9,640.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,858.83
|
| Rate for Payer: Multiplan Commercial |
$8,382.75
|
| Rate for Payer: NAPHCARE Commercial |
$6,287.06
|
| Rate for Payer: Preferred Network Access Commercial |
$9,640.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,134.43
|
| Rate for Payer: Quartz Commercial |
$6,810.98
|
| Rate for Payer: Quartz Medicare Advantage |
$6,287.06
|
| Rate for Payer: The Alliance Commercial |
$5,239.22
|
| Rate for Payer: WEA Trust Commercial |
$5,763.14
|
| Rate for Payer: WPS Commercial |
$7,761.10
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 3 16MM 5537-G-316
|
Facility
|
IP
|
$13,197.00
|
|
| Hospital Charge Code |
5179235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,725.19 |
| Max. Negotiated Rate |
$12,626.89 |
| Rate for Payer: Aetna Commercial |
$12,352.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,803.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,274.19
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna Commercial |
$12,626.89
|
| Rate for Payer: Health EOS Commercial |
$12,215.14
|
| Rate for Payer: HFN Commercial |
$12,626.89
|
| Rate for Payer: Multiplan Commercial |
$10,979.90
|
| Rate for Payer: Preferred Network Access Commercial |
$12,626.89
|
| Rate for Payer: Quartz Beloit One Network |
$6,725.19
|
| Rate for Payer: Quartz Commercial |
$8,234.93
|
| Rate for Payer: WEA Trust Commercial |
$7,548.68
|
| Rate for Payer: WPS Commercial |
$10,165.65
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 3 16MM 5537-G-316
|
Facility
|
OP
|
$13,197.00
|
|
| Hospital Charge Code |
5179235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,842.97 |
| Max. Negotiated Rate |
$12,626.89 |
| Rate for Payer: Aetna Commercial |
$12,352.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,803.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,842.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,921.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,862.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,587.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,274.19
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna Commercial |
$12,626.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,680.65
|
| Rate for Payer: Health EOS Commercial |
$12,215.14
|
| Rate for Payer: HFN Commercial |
$12,626.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,293.66
|
| Rate for Payer: Multiplan Commercial |
$10,979.90
|
| Rate for Payer: NAPHCARE Commercial |
$8,234.93
|
| Rate for Payer: Preferred Network Access Commercial |
$12,626.89
|
| Rate for Payer: Quartz Beloit One Network |
$6,725.19
|
| Rate for Payer: Quartz Commercial |
$8,921.17
|
| Rate for Payer: Quartz Medicare Advantage |
$8,234.93
|
| Rate for Payer: The Alliance Commercial |
$6,862.44
|
| Rate for Payer: WEA Trust Commercial |
$7,548.68
|
| Rate for Payer: WPS Commercial |
$10,165.65
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 11MM 5532-G-611
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 11MM 5532-G-611
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 13MM 5532-G-613
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 13MM 5532-G-613
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 19MM 5532-G-619
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 19MM 5532-G-619
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
