|
KNEE PATELLECTOMY
|
Facility
|
IP
|
$4,492.00
|
|
| Hospital Charge Code |
2960308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.08 |
| Max. Negotiated Rate |
$4,132.64 |
| Rate for Payer: Aetna Commercial |
$4,042.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.12
|
| 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: Health EOS Commercial |
$3,997.88
|
| Rate for Payer: HFN Commercial |
$4,132.64
|
| 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 |
$2,695.20
|
| Rate for Payer: WEA Trust Commercial |
$2,470.60
|
| Rate for Payer: WPS Commercial |
$3,327.22
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$56,326.00
|
|
|
Service Code
|
MSDRG 488
|
| Min. Negotiated Rate |
$20,261.30 |
| Max. Negotiated Rate |
$56,326.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,261.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,930.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,236.58
|
| Rate for Payer: Anthem Medicare Advantage |
$20,261.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,261.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,261.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,261.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,785.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,261.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,078.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,261.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,261.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,261.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,261.30
|
| Rate for Payer: NAPHCARE Commercial |
$30,391.95
|
| Rate for Payer: Quartz Medicare Advantage |
$20,261.30
|
| Rate for Payer: The Alliance Commercial |
$56,326.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,261.30
|
| Rate for Payer: United Healthcare PPO |
$31,980.29
|
| Rate for Payer: Wellcare Medicare |
$20,261.30
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$33,226.00
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$11,951.75 |
| Max. Negotiated Rate |
$33,226.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,951.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,015.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,940.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,944.72
|
| Rate for Payer: Anthem Medicare Advantage |
$11,951.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,951.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,951.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,951.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,030.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,951.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,135.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,951.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,951.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,951.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,951.75
|
| Rate for Payer: NAPHCARE Commercial |
$17,927.62
|
| Rate for Payer: Quartz Medicare Advantage |
$11,951.75
|
| Rate for Payer: The Alliance Commercial |
$33,226.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,951.75
|
| Rate for Payer: United Healthcare PPO |
$18,789.52
|
| Rate for Payer: Wellcare Medicare |
$11,951.75
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$53,713.00
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$19,321.23 |
| Max. Negotiated Rate |
$53,713.00 |
| Rate for Payer: Wellcare Medicare |
$19,321.23
|
| Rate for Payer: Aetna Managed Medicare |
$19,321.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,169.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,322.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,708.78
|
| Rate for Payer: Anthem Medicare Advantage |
$19,321.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,321.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,321.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,321.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,089.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,321.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,161.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,321.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,321.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,321.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,321.23
|
| Rate for Payer: NAPHCARE Commercial |
$28,981.84
|
| Rate for Payer: Quartz Medicare Advantage |
$19,321.23
|
| Rate for Payer: The Alliance Commercial |
$53,713.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,321.23
|
| Rate for Payer: United Healthcare PPO |
$30,488.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$87,895.00
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$31,616.75 |
| Max. Negotiated Rate |
$87,895.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,616.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,024.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,906.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,264.62
|
| Rate for Payer: Anthem Medicare Advantage |
$31,616.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,616.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,616.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,616.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55,798.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,616.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,233.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,616.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,616.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,616.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,616.75
|
| Rate for Payer: NAPHCARE Commercial |
$47,425.12
|
| Rate for Payer: Quartz Medicare Advantage |
$31,616.75
|
| Rate for Payer: The Alliance Commercial |
$87,895.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,616.75
|
| Rate for Payer: United Healthcare PPO |
$50,006.21
|
| Rate for Payer: Wellcare Medicare |
$31,616.75
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$41,393.00
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$14,889.59 |
| Max. Negotiated Rate |
$41,393.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,889.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,309.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,764.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,528.12
|
| Rate for Payer: Anthem Medicare Advantage |
$14,889.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,889.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,889.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,889.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,118.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,889.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,125.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,889.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,889.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,889.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,889.59
|
| Rate for Payer: NAPHCARE Commercial |
$22,334.38
|
| Rate for Payer: Quartz Medicare Advantage |
$14,889.59
|
| Rate for Payer: The Alliance Commercial |
$41,393.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,889.59
|
| Rate for Payer: United Healthcare PPO |
$23,453.13
|
| Rate for Payer: Wellcare Medicare |
$14,889.59
|
|
|
KNEE SUPPORT MED WITH OPEN PATELLA NE7702-73
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2974247
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
KNEE SUPPORT MED WITH OPEN PATELLA NE7702-73
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2974247
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
KNEE, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960424
|
|
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, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960424
|
|
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
|
|
|
KNIFE 2.4 SLIT CLEARCUT 8065982465
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
2964174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.97 |
| Max. Negotiated Rate |
$508.76 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.09
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$508.76
|
| Rate for Payer: Health EOS Commercial |
$492.17
|
| Rate for Payer: HFN Commercial |
$508.76
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: NAPHCARE Commercial |
$331.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.76
|
| Rate for Payer: Quartz Beloit One Network |
$270.97
|
| Rate for Payer: Quartz Commercial |
$331.80
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
KNIFE 2.4 SLIT CLEARCUT 8065982465
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
2964174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$2,212.00 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Aetna Managed Medicare |
$154.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.09
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$508.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.46
|
| Rate for Payer: Health EOS Commercial |
$492.17
|
| Rate for Payer: HFN Commercial |
$508.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.75
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: NAPHCARE Commercial |
$331.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.76
|
| Rate for Payer: Quartz Beloit One Network |
$270.97
|
| Rate for Payer: Quartz Commercial |
$359.45
|
| Rate for Payer: Quartz Medicare Advantage |
$331.80
|
| Rate for Payer: The Alliance Commercial |
$2,212.00
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
KNIFE 2.5 ANGLED SLIT E7550A
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2964766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
KNIFE 2.5 ANGLED SLIT E7550A
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2964766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
KNIFE 2.65 STRAIGHT SLIT 622-00W5441-06
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
2967393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Aetna Managed Medicare |
$57.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.84
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$134.55
|
| Rate for Payer: Quartz Medicare Advantage |
$124.20
|
| Rate for Payer: The Alliance Commercial |
$828.00
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
KNIFE 2.65 STRAIGHT SLIT 622-00W5441-06
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
2967393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$190.44 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$124.20
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
KNIFE 3.5 ANG SHORT CUT 8065993561
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
2964175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
KNIFE 3.5 ANG SHORT CUT 8065993561
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
2964175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$93.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$199.80
|
| Rate for Payer: The Alliance Commercial |
$1,332.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
KNIFE 4.1 ANG SHORT CUT 8065994061
|
Facility
|
IP
|
$474.00
|
|
| Hospital Charge Code |
6065629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.26 |
| Max. Negotiated Rate |
$436.08 |
| Rate for Payer: Aetna Commercial |
$426.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.22
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$436.08
|
| Rate for Payer: Health EOS Commercial |
$421.86
|
| Rate for Payer: HFN Commercial |
$436.08
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: NAPHCARE Commercial |
$284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$436.08
|
| Rate for Payer: Quartz Beloit One Network |
$232.26
|
| Rate for Payer: Quartz Commercial |
$284.40
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
KNIFE 4.1 ANG SHORT CUT 8065994061
|
Facility
|
OP
|
$474.00
|
|
| Hospital Charge Code |
6065629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$1,896.00 |
| Rate for Payer: Aetna Commercial |
$426.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Aetna Managed Medicare |
$132.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.22
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$436.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.25
|
| Rate for Payer: Health EOS Commercial |
$421.86
|
| Rate for Payer: HFN Commercial |
$436.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.50
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: NAPHCARE Commercial |
$284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$436.08
|
| Rate for Payer: Quartz Beloit One Network |
$232.26
|
| Rate for Payer: Quartz Commercial |
$308.10
|
| Rate for Payer: Quartz Medicare Advantage |
$284.40
|
| Rate for Payer: The Alliance Commercial |
$1,896.00
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
KNIFE CRESCENT ANG 8065-990002
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
2964176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$93.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$199.80
|
| Rate for Payer: The Alliance Commercial |
$1,332.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
KNIFE CRESCENT ANG 8065-990002
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
2964176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
KNIFE MICROSURGICAL BAYONET
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2965956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
KNIFE MICROSURGICAL BAYONET
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2965956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
KNIFE MICROSURGICAL STRAIGHT
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2965957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
