|
KIT VTC NEPHROSTOMY 10fr M001271870
|
Facility
|
OP
|
$2,178.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2973047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$609.84 |
| Max. Negotiated Rate |
$8,712.00 |
| Rate for Payer: Aetna Commercial |
$1,960.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.08
|
| Rate for Payer: Aetna Managed Medicare |
$609.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,415.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.34
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna Commercial |
$2,003.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,218.81
|
| Rate for Payer: Health EOS Commercial |
$1,938.42
|
| Rate for Payer: HFN Commercial |
$2,003.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,633.50
|
| Rate for Payer: Multiplan Commercial |
$1,742.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,306.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,003.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.22
|
| Rate for Payer: Quartz Commercial |
$1,415.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,306.80
|
| Rate for Payer: The Alliance Commercial |
$8,712.00
|
| Rate for Payer: WEA Trust Commercial |
$1,197.90
|
| Rate for Payer: WPS Commercial |
$1,613.24
|
|
|
KIT WOUND DRESSING PREVENA VAC 13CM PRE1101US
|
Facility
|
IP
|
$5,015.00
|
|
| Hospital Charge Code |
2974017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,457.35 |
| Max. Negotiated Rate |
$4,613.80 |
| Rate for Payer: Aetna Commercial |
$4,513.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,312.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,657.95
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$4,613.80
|
| Rate for Payer: Health EOS Commercial |
$4,463.35
|
| Rate for Payer: HFN Commercial |
$4,613.80
|
| Rate for Payer: Multiplan Commercial |
$4,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,009.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,613.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,457.35
|
| Rate for Payer: Quartz Commercial |
$3,009.00
|
| Rate for Payer: WEA Trust Commercial |
$2,758.25
|
| Rate for Payer: WPS Commercial |
$3,714.61
|
|
|
KIT WOUND DRESSING PREVENA VAC 13CM PRE1101US
|
Facility
|
OP
|
$5,015.00
|
|
| Hospital Charge Code |
2974017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$20,060.00 |
| Rate for Payer: Aetna Commercial |
$4,513.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,312.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,404.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,259.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,507.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,407.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,657.95
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$4,613.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,806.39
|
| Rate for Payer: Health EOS Commercial |
$4,463.35
|
| Rate for Payer: HFN Commercial |
$4,613.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,761.25
|
| Rate for Payer: Multiplan Commercial |
$4,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,009.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,613.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,457.35
|
| Rate for Payer: Quartz Commercial |
$3,259.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,009.00
|
| Rate for Payer: The Alliance Commercial |
$20,060.00
|
| Rate for Payer: WEA Trust Commercial |
$2,758.25
|
| Rate for Payer: WPS Commercial |
$3,714.61
|
|
|
KIT WOUND DRESSING PREVENA VAC 20CM PRE1001US
|
Facility
|
IP
|
$6,273.00
|
|
| Hospital Charge Code |
2975059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,073.77 |
| Max. Negotiated Rate |
$5,771.16 |
| Rate for Payer: Aetna Commercial |
$5,645.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,394.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,324.69
|
| Rate for Payer: Cash Price |
$1,881.90
|
| Rate for Payer: Cigna Commercial |
$5,771.16
|
| Rate for Payer: Health EOS Commercial |
$5,582.97
|
| Rate for Payer: HFN Commercial |
$5,771.16
|
| Rate for Payer: Multiplan Commercial |
$5,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,763.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,771.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,073.77
|
| Rate for Payer: Quartz Commercial |
$3,763.80
|
| Rate for Payer: WEA Trust Commercial |
$3,450.15
|
| Rate for Payer: WPS Commercial |
$4,646.41
|
|
|
KIT WOUND DRESSING PREVENA VAC 20CM PRE1001US
|
Facility
|
OP
|
$6,273.00
|
|
| Hospital Charge Code |
2975059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,756.44 |
| Max. Negotiated Rate |
$25,092.00 |
| Rate for Payer: Aetna Commercial |
$5,645.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,394.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,756.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,077.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,136.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,011.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,324.69
|
| Rate for Payer: Cash Price |
$1,881.90
|
| Rate for Payer: Cigna Commercial |
$5,771.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.37
|
| Rate for Payer: Health EOS Commercial |
$5,582.97
|
| Rate for Payer: HFN Commercial |
$5,771.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,704.75
|
| Rate for Payer: Multiplan Commercial |
$5,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,763.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,771.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,073.77
|
| Rate for Payer: Quartz Commercial |
$4,077.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,763.80
|
| Rate for Payer: The Alliance Commercial |
$25,092.00
|
| Rate for Payer: WEA Trust Commercial |
$3,450.15
|
| Rate for Payer: WPS Commercial |
$4,646.41
|
|
|
KIT WOUND DRESSING PREVENA VAC 35CM PRE3201US
|
Facility
|
OP
|
$5,937.00
|
|
| Hospital Charge Code |
5414738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,662.36 |
| Max. Negotiated Rate |
$23,748.00 |
| Rate for Payer: Aetna Commercial |
$5,343.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,105.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,662.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,859.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,968.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,849.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,146.61
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cigna Commercial |
$5,462.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,322.35
|
| Rate for Payer: Health EOS Commercial |
$5,283.93
|
| Rate for Payer: HFN Commercial |
$5,462.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,452.75
|
| Rate for Payer: Multiplan Commercial |
$4,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,562.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,462.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,909.13
|
| Rate for Payer: Quartz Commercial |
$3,859.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,562.20
|
| Rate for Payer: The Alliance Commercial |
$23,748.00
|
| Rate for Payer: WEA Trust Commercial |
$3,265.35
|
| Rate for Payer: WPS Commercial |
$4,397.54
|
|
|
KIT WOUND DRESSING PREVENA VAC 35CM PRE3201US
|
Facility
|
IP
|
$5,937.00
|
|
| Hospital Charge Code |
5414738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,909.13 |
| Max. Negotiated Rate |
$5,462.04 |
| Rate for Payer: Aetna Commercial |
$5,343.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,105.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,146.61
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cigna Commercial |
$5,462.04
|
| Rate for Payer: Health EOS Commercial |
$5,283.93
|
| Rate for Payer: HFN Commercial |
$5,462.04
|
| Rate for Payer: Multiplan Commercial |
$4,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,562.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,462.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,909.13
|
| Rate for Payer: Quartz Commercial |
$3,562.20
|
| Rate for Payer: WEA Trust Commercial |
$3,265.35
|
| Rate for Payer: WPS Commercial |
$4,397.54
|
|
|
KNEE ARTHROPLASTY, TOTAL
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
2960531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,721.48 |
| Max. Negotiated Rate |
$53,164.00 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Aetna Managed Medicare |
$3,721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,639.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,645.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,379.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,437.64
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,968.25
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$8,639.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,974.60
|
| Rate for Payer: The Alliance Commercial |
$53,164.00
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
KNEE ARTHROPLASTY, TOTAL
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
2960531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,512.59 |
| Max. Negotiated Rate |
$12,227.72 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$7,974.60
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
KNEE ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
IP
|
$19,936.00
|
|
| Hospital Charge Code |
2960532
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,768.64 |
| Max. Negotiated Rate |
$18,341.12 |
| Rate for Payer: Aetna Commercial |
$17,942.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,566.08
|
| Rate for Payer: Cash Price |
$5,980.80
|
| Rate for Payer: Cigna Commercial |
$18,341.12
|
| Rate for Payer: Health EOS Commercial |
$17,743.04
|
| Rate for Payer: HFN Commercial |
$18,341.12
|
| Rate for Payer: Multiplan Commercial |
$15,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,961.60
|
| Rate for Payer: Preferred Network Access Commercial |
$18,341.12
|
| Rate for Payer: Quartz Beloit One Network |
$9,768.64
|
| Rate for Payer: Quartz Commercial |
$11,961.60
|
| Rate for Payer: WEA Trust Commercial |
$10,964.80
|
| Rate for Payer: WPS Commercial |
$14,766.60
|
|
|
KNEE ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
OP
|
$19,936.00
|
|
| Hospital Charge Code |
2960532
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,582.08 |
| Max. Negotiated Rate |
$79,744.00 |
| Rate for Payer: Aetna Commercial |
$17,942.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,144.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,582.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,958.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,968.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,569.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,566.08
|
| Rate for Payer: Cash Price |
$5,980.80
|
| Rate for Payer: Cigna Commercial |
$18,341.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,156.19
|
| Rate for Payer: Health EOS Commercial |
$17,743.04
|
| Rate for Payer: HFN Commercial |
$18,341.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,952.00
|
| Rate for Payer: Multiplan Commercial |
$15,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,961.60
|
| Rate for Payer: Preferred Network Access Commercial |
$18,341.12
|
| Rate for Payer: Quartz Beloit One Network |
$9,768.64
|
| Rate for Payer: Quartz Commercial |
$12,958.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11,961.60
|
| Rate for Payer: The Alliance Commercial |
$79,744.00
|
| Rate for Payer: WEA Trust Commercial |
$10,964.80
|
| Rate for Payer: WPS Commercial |
$14,766.60
|
|
|
KNEE ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
2960353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,512.59 |
| Max. Negotiated Rate |
$12,227.72 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$7,974.60
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
KNEE ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
2960353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,721.48 |
| Max. Negotiated Rate |
$53,164.00 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Aetna Managed Medicare |
$3,721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,639.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,645.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,379.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,437.64
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,968.25
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$8,639.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,974.60
|
| Rate for Payer: The Alliance Commercial |
$53,164.00
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
KNEE ARTHROSCOPY
|
Facility
|
IP
|
$8,560.00
|
|
| Hospital Charge Code |
2959829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,194.40 |
| Max. Negotiated Rate |
$7,875.20 |
| Rate for Payer: Aetna Commercial |
$7,704.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,536.80
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$7,875.20
|
| Rate for Payer: Health EOS Commercial |
$7,618.40
|
| Rate for Payer: HFN Commercial |
$7,875.20
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,875.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,194.40
|
| Rate for Payer: Quartz Commercial |
$5,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,708.00
|
| Rate for Payer: WPS Commercial |
$6,340.39
|
|
|
KNEE ARTHROSCOPY
|
Facility
|
OP
|
$8,560.00
|
|
| Hospital Charge Code |
2959829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.80 |
| Max. Negotiated Rate |
$34,240.00 |
| Rate for Payer: Aetna Commercial |
$7,704.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,361.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,396.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,564.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,108.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,536.80
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$7,875.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,790.18
|
| Rate for Payer: Health EOS Commercial |
$7,618.40
|
| Rate for Payer: HFN Commercial |
$7,875.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,420.00
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,875.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,194.40
|
| Rate for Payer: Quartz Commercial |
$5,564.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,136.00
|
| Rate for Payer: The Alliance Commercial |
$34,240.00
|
| Rate for Payer: WEA Trust Commercial |
$4,708.00
|
| Rate for Payer: WPS Commercial |
$6,340.39
|
|
|
KNEE ARTHROSCOPY, DX 29870
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
3014328
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$451.08 |
| Max. Negotiated Rate |
$1,871.50 |
| Rate for Payer: Aetna Commercial |
$1,871.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,694.20
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$1,871.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$451.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.00
|
| Rate for Payer: Health EOS Commercial |
$1,792.70
|
| Rate for Payer: HFN Commercial |
$1,871.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,353.40
|
| Rate for Payer: Multiplan Commercial |
$1,576.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.50
|
| Rate for Payer: Quartz Beloit One Network |
$866.80
|
| Rate for Payer: Quartz Commercial |
$1,122.90
|
| Rate for Payer: The Alliance Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicaid |
$451.08
|
| Rate for Payer: WEA Trust Commercial |
$1,083.50
|
| Rate for Payer: WPS Commercial |
$1,459.18
|
|
|
KNEE ARTHROTOMY/ARTHRODESIS/BURSECTOMY/OSTEOTOMY
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2959825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,406.88 |
| Max. Negotiated Rate |
$4,519.04 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$2,947.20
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
KNEE ARTHROTOMY/ARTHRODESIS/BURSECTOMY/OSTEOTOMY
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2959825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.36 |
| Max. Negotiated Rate |
$19,648.00 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,192.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.76
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,684.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$3,192.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,947.20
|
| Rate for Payer: The Alliance Commercial |
$19,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
KNEE BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959864
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
KNEE BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959864
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
KNEE BRACE HINGED L1831
|
Facility
|
OP
|
$3,049.00
|
|
| Hospital Charge Code |
2974047
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$853.72 |
| Max. Negotiated Rate |
$12,196.00 |
| Rate for Payer: Aetna Commercial |
$2,744.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,622.14
|
| Rate for Payer: Aetna Managed Medicare |
$853.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,981.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,524.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,463.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.97
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,805.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,706.22
|
| Rate for Payer: Health EOS Commercial |
$2,713.61
|
| Rate for Payer: HFN Commercial |
$2,805.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,286.75
|
| Rate for Payer: Multiplan Commercial |
$2,439.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,829.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,805.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.01
|
| Rate for Payer: Quartz Commercial |
$1,981.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,829.40
|
| Rate for Payer: The Alliance Commercial |
$12,196.00
|
| Rate for Payer: WEA Trust Commercial |
$1,676.95
|
| Rate for Payer: WPS Commercial |
$2,258.39
|
|
|
KNEE BRACE HINGED L1831
|
Facility
|
IP
|
$3,049.00
|
|
| Hospital Charge Code |
2974047
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,494.01 |
| Max. Negotiated Rate |
$2,805.08 |
| Rate for Payer: Aetna Commercial |
$2,744.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,622.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.97
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,805.08
|
| Rate for Payer: Health EOS Commercial |
$2,713.61
|
| Rate for Payer: HFN Commercial |
$2,805.08
|
| Rate for Payer: Multiplan Commercial |
$2,439.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,829.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,805.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.01
|
| Rate for Payer: Quartz Commercial |
$1,829.40
|
| Rate for Payer: WEA Trust Commercial |
$1,676.95
|
| Rate for Payer: WPS Commercial |
$2,258.39
|
|
|
KNEE BRACE XL 5674-BLK-XL
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
3072382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$287.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.59
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$666.25
|
| Rate for Payer: Quartz Medicare Advantage |
$615.00
|
| Rate for Payer: The Alliance Commercial |
$4,100.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
KNEE BRACE XL 5674-BLK-XL
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
3072382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$943.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$615.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
KNEE PATELLECTOMY
|
Facility
|
OP
|
$4,492.00
|
|
| Hospital Charge Code |
2960308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,257.76 |
| Max. Negotiated Rate |
$17,968.00 |
| Rate for Payer: Aetna Commercial |
$4,042.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,919.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,246.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,156.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,380.76
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,132.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,513.72
|
| Rate for Payer: Health EOS Commercial |
$3,997.88
|
| Rate for Payer: HFN Commercial |
$4,132.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,369.00
|
| Rate for Payer: Multiplan Commercial |
$3,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,132.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.08
|
| Rate for Payer: Quartz Commercial |
$2,919.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,695.20
|
| Rate for Payer: The Alliance Commercial |
$17,968.00
|
| Rate for Payer: WEA Trust Commercial |
$2,470.60
|
| Rate for Payer: WPS Commercial |
$3,327.22
|
|
