|
KIT SHOULDER SPACER SM 41MM SBS0121K
|
Facility
|
IP
|
$20,049.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,216.97 |
| Max. Negotiated Rate |
$19,182.88 |
| Rate for Payer: Aetna Commercial |
$18,765.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,931.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,051.01
|
| Rate for Payer: Cash Price |
$6,014.70
|
| Rate for Payer: Cigna Commercial |
$19,182.88
|
| Rate for Payer: Health EOS Commercial |
$18,557.35
|
| Rate for Payer: HFN Commercial |
$19,182.88
|
| Rate for Payer: Multiplan Commercial |
$16,680.77
|
| Rate for Payer: Preferred Network Access Commercial |
$19,182.88
|
| Rate for Payer: Quartz Beloit One Network |
$10,216.97
|
| Rate for Payer: Quartz Commercial |
$12,510.58
|
| Rate for Payer: WEA Trust Commercial |
$11,468.03
|
| Rate for Payer: WPS Commercial |
$15,443.74
|
|
|
KIT SHOULDER SPACER SM 41MM SBS0121K
|
Facility
|
OP
|
$20,049.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,838.27 |
| Max. Negotiated Rate |
$19,182.88 |
| Rate for Payer: Aetna Commercial |
$18,765.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,931.83
|
| Rate for Payer: Aetna Managed Medicare |
$5,838.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,553.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,425.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,008.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,051.01
|
| Rate for Payer: Cash Price |
$6,014.70
|
| Rate for Payer: Cigna Commercial |
$19,182.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,668.52
|
| Rate for Payer: Health EOS Commercial |
$18,557.35
|
| Rate for Payer: HFN Commercial |
$19,182.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,638.22
|
| Rate for Payer: Multiplan Commercial |
$16,680.77
|
| Rate for Payer: NAPHCARE Commercial |
$12,510.58
|
| Rate for Payer: Preferred Network Access Commercial |
$19,182.88
|
| Rate for Payer: Quartz Beloit One Network |
$10,216.97
|
| Rate for Payer: Quartz Commercial |
$13,553.12
|
| Rate for Payer: Quartz Medicare Advantage |
$12,510.58
|
| Rate for Payer: The Alliance Commercial |
$10,425.48
|
| Rate for Payer: WEA Trust Commercial |
$11,468.03
|
| Rate for Payer: WPS Commercial |
$15,443.74
|
|
|
KIT SHOULDER STABILIZER (SPIDER S&N) 7210573
|
Facility
|
IP
|
$1,380.00
|
|
| Hospital Charge Code |
6214966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.25 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$861.12
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
KIT SHOULDER STABILIZER (SPIDER S&N) 7210573
|
Facility
|
OP
|
$1,380.00
|
|
| Hospital Charge Code |
6214966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Aetna Managed Medicare |
$401.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.16
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: NAPHCARE Commercial |
$861.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$932.88
|
| Rate for Payer: Quartz Medicare Advantage |
$861.12
|
| Rate for Payer: The Alliance Commercial |
$717.60
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
KIT SHOULDER SUSPENSION (DYONICS) 72200195
|
Facility
|
OP
|
$1,822.00
|
|
| Hospital Charge Code |
6214967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.57 |
| Max. Negotiated Rate |
$1,743.29 |
| Rate for Payer: Aetna Commercial |
$1,705.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.60
|
| Rate for Payer: Aetna Managed Medicare |
$530.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.29
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$1,743.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.40
|
| Rate for Payer: Health EOS Commercial |
$1,686.44
|
| Rate for Payer: HFN Commercial |
$1,743.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.16
|
| Rate for Payer: Multiplan Commercial |
$1,515.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,136.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.29
|
| Rate for Payer: Quartz Beloit One Network |
$928.49
|
| Rate for Payer: Quartz Commercial |
$1,231.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,136.93
|
| Rate for Payer: The Alliance Commercial |
$947.44
|
| Rate for Payer: WEA Trust Commercial |
$1,042.18
|
| Rate for Payer: WPS Commercial |
$1,403.49
|
|
|
KIT SHOULDER SUSPENSION (DYONICS) 72200195
|
Facility
|
IP
|
$1,822.00
|
|
| Hospital Charge Code |
6214967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.49 |
| Max. Negotiated Rate |
$1,743.29 |
| Rate for Payer: Aetna Commercial |
$1,705.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.29
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$1,743.29
|
| Rate for Payer: Health EOS Commercial |
$1,686.44
|
| Rate for Payer: HFN Commercial |
$1,743.29
|
| Rate for Payer: Multiplan Commercial |
$1,515.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.29
|
| Rate for Payer: Quartz Beloit One Network |
$928.49
|
| Rate for Payer: Quartz Commercial |
$1,136.93
|
| Rate for Payer: WEA Trust Commercial |
$1,042.18
|
| Rate for Payer: WPS Commercial |
$1,403.49
|
|
|
KIT SUTURE LACERATION
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
2963040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
KIT SUTURE LACERATION
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
2963040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.74
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$51.79
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$51.79
|
| Rate for Payer: The Alliance Commercial |
$43.16
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
KIT SUTURETAK PERC INSERTION AR-1934PI
|
Facility
|
OP
|
$3,404.00
|
|
| Hospital Charge Code |
2964686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.24 |
| Max. Negotiated Rate |
$3,256.95 |
| Rate for Payer: Aetna Commercial |
$3,186.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,044.54
|
| Rate for Payer: Aetna Managed Medicare |
$991.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,301.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,770.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,699.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,256.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,981.13
|
| Rate for Payer: Health EOS Commercial |
$3,150.74
|
| Rate for Payer: HFN Commercial |
$3,256.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,655.12
|
| Rate for Payer: Multiplan Commercial |
$2,832.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,124.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,256.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.68
|
| Rate for Payer: Quartz Commercial |
$2,301.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,124.10
|
| Rate for Payer: The Alliance Commercial |
$1,770.08
|
| Rate for Payer: WEA Trust Commercial |
$1,947.09
|
| Rate for Payer: WPS Commercial |
$2,622.10
|
|
|
KIT SUTURETAK PERC INSERTION AR-1934PI
|
Facility
|
IP
|
$3,404.00
|
|
| Hospital Charge Code |
2964686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,734.68 |
| Max. Negotiated Rate |
$3,256.95 |
| Rate for Payer: Aetna Commercial |
$3,186.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,044.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,256.95
|
| Rate for Payer: Health EOS Commercial |
$3,150.74
|
| Rate for Payer: HFN Commercial |
$3,256.95
|
| Rate for Payer: Multiplan Commercial |
$2,832.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,256.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.68
|
| Rate for Payer: Quartz Commercial |
$2,124.10
|
| Rate for Payer: WEA Trust Commercial |
$1,947.09
|
| Rate for Payer: WPS Commercial |
$2,622.10
|
|
|
KIT SYSTEM INTERNAL BRACE HAND/WRIST LIGAMENT AUGMENT REPAIR AR-8978-CP
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,789.57 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,089.26
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
KIT SYSTEM INTERNAL BRACE HAND/WRIST LIGAMENT AUGMENT REPAIR AR-8978-CP
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.32 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,308.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,680.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,907.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,671.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,612.10
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,861.58
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: NAPHCARE Commercial |
$7,089.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,680.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7,089.26
|
| Rate for Payer: The Alliance Commercial |
$5,907.72
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
KIT TENODESIS GRAFT SIZING W FIBERLOOK SUTURETAPE & NEEDLE AR-1676ST
|
Facility
|
OP
|
$2,790.00
|
|
| Hospital Charge Code |
6185036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Aetna Managed Medicare |
$812.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.78
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,886.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.96
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
KIT TENODESIS GRAFT SIZING W FIBERLOOK SUTURETAPE & NEEDLE AR-1676ST
|
Facility
|
IP
|
$2,790.00
|
|
| Hospital Charge Code |
6185036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.78 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,740.96
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
KIT THD SLIDE ONE STERILE PROCEDURE 800070
|
Facility
|
OP
|
$4,968.00
|
|
| Hospital Charge Code |
4226511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,446.68 |
| Max. Negotiated Rate |
$4,753.38 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,443.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,446.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,358.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,583.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,480.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,738.36
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,753.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,891.38
|
| Rate for Payer: Health EOS Commercial |
$4,598.38
|
| Rate for Payer: HFN Commercial |
$4,753.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,875.04
|
| Rate for Payer: Multiplan Commercial |
$4,133.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,100.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,753.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.69
|
| Rate for Payer: Quartz Commercial |
$3,358.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,100.03
|
| Rate for Payer: The Alliance Commercial |
$2,583.36
|
| Rate for Payer: WEA Trust Commercial |
$2,841.70
|
| Rate for Payer: WPS Commercial |
$3,826.85
|
|
|
KIT THD SLIDE ONE STERILE PROCEDURE 800070
|
Facility
|
IP
|
$4,968.00
|
|
| Hospital Charge Code |
4226511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,531.69 |
| Max. Negotiated Rate |
$4,753.38 |
| Rate for Payer: Aetna Commercial |
$4,650.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,443.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,738.36
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,753.38
|
| Rate for Payer: Health EOS Commercial |
$4,598.38
|
| Rate for Payer: HFN Commercial |
$4,753.38
|
| Rate for Payer: Multiplan Commercial |
$4,133.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,753.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.69
|
| Rate for Payer: Quartz Commercial |
$3,100.03
|
| Rate for Payer: WEA Trust Commercial |
$2,841.70
|
| Rate for Payer: WPS Commercial |
$3,826.85
|
|
|
KIT THORACENTESIS
|
Facility
|
IP
|
$739.00
|
|
| Hospital Charge Code |
2963544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
KIT THORACENTESIS
|
Facility
|
OP
|
$739.00
|
|
| Hospital Charge Code |
2963544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
KIT TRANSDUCER DOUBLE LINE MONITORING 42652-05
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
2963102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
KIT TRANSDUCER DOUBLE LINE MONITORING 42652-05
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
2963102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
KIT TRANSDUCER SINGLE LINE 42584-05
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2963067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
KIT TRANSDUCER SINGLE LINE 42584-05
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2963067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$197.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$182.21
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
KIT TRANSTIBIAL ACL DISPOSABLE AR-1898S
|
Facility
|
OP
|
$3,611.00
|
|
| Hospital Charge Code |
2964687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,051.52 |
| Max. Negotiated Rate |
$3,455.00 |
| Rate for Payer: Aetna Commercial |
$3,379.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,229.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,051.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,441.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,877.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,802.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,990.38
|
| Rate for Payer: Cash Price |
$1,083.30
|
| Rate for Payer: Cigna Commercial |
$3,455.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,101.60
|
| Rate for Payer: Health EOS Commercial |
$3,342.34
|
| Rate for Payer: HFN Commercial |
$3,455.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,816.58
|
| Rate for Payer: Multiplan Commercial |
$3,004.35
|
| Rate for Payer: NAPHCARE Commercial |
$2,253.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,455.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.17
|
| Rate for Payer: Quartz Commercial |
$2,441.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,253.26
|
| Rate for Payer: The Alliance Commercial |
$1,877.72
|
| Rate for Payer: WEA Trust Commercial |
$2,065.49
|
| Rate for Payer: WPS Commercial |
$2,781.55
|
|
|
KIT TRANSTIBIAL ACL DISPOSABLE AR-1898S
|
Facility
|
IP
|
$3,611.00
|
|
| Hospital Charge Code |
2964687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,840.17 |
| Max. Negotiated Rate |
$3,455.00 |
| Rate for Payer: Aetna Commercial |
$3,379.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,229.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,990.38
|
| Rate for Payer: Cash Price |
$1,083.30
|
| Rate for Payer: Cigna Commercial |
$3,455.00
|
| Rate for Payer: Health EOS Commercial |
$3,342.34
|
| Rate for Payer: HFN Commercial |
$3,455.00
|
| Rate for Payer: Multiplan Commercial |
$3,004.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,455.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.17
|
| Rate for Payer: Quartz Commercial |
$2,253.26
|
| Rate for Payer: WEA Trust Commercial |
$2,065.49
|
| Rate for Payer: WPS Commercial |
$2,781.55
|
|
|
KIT TRAUMA AK-05801
|
Facility
|
IP
|
$596.00
|
|
| Hospital Charge Code |
2962981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
