|
KIT TRAUMA AK-05801
|
Facility
|
OP
|
$596.00
|
|
| Hospital Charge Code |
2962981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.52
|
| 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: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
KIT TRIMANO ARM POSITIONER
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
KIT TRIMANO ARM POSITIONER
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
KIT UCL SUTURE PASSING DISP AR-7715-4.5
|
Facility
|
IP
|
$7,618.00
|
|
| Hospital Charge Code |
5923707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,882.13 |
| Max. Negotiated Rate |
$7,288.90 |
| Rate for Payer: Aetna Commercial |
$7,130.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,813.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,199.04
|
| Rate for Payer: Cash Price |
$2,285.40
|
| Rate for Payer: Cigna Commercial |
$7,288.90
|
| Rate for Payer: Health EOS Commercial |
$7,051.22
|
| Rate for Payer: HFN Commercial |
$7,288.90
|
| Rate for Payer: Multiplan Commercial |
$6,338.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,882.13
|
| Rate for Payer: Quartz Commercial |
$4,753.63
|
| Rate for Payer: WEA Trust Commercial |
$4,357.50
|
| Rate for Payer: WPS Commercial |
$5,868.15
|
|
|
KIT UCL SUTURE PASSING DISP AR-7715-4.5
|
Facility
|
OP
|
$7,618.00
|
|
| Hospital Charge Code |
5923707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,218.36 |
| Max. Negotiated Rate |
$7,288.90 |
| Rate for Payer: Aetna Commercial |
$7,130.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,813.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,218.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,149.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,961.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,802.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,199.04
|
| Rate for Payer: Cash Price |
$2,285.40
|
| Rate for Payer: Cigna Commercial |
$7,288.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,433.68
|
| Rate for Payer: Health EOS Commercial |
$7,051.22
|
| Rate for Payer: HFN Commercial |
$7,288.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,942.04
|
| Rate for Payer: Multiplan Commercial |
$6,338.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,753.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,882.13
|
| Rate for Payer: Quartz Commercial |
$5,149.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,753.63
|
| Rate for Payer: The Alliance Commercial |
$3,961.36
|
| Rate for Payer: WEA Trust Commercial |
$4,357.50
|
| Rate for Payer: WPS Commercial |
$5,868.15
|
|
|
KIT UROMAX DILATION 30FR X 4CM M0062251050
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4595300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.01 |
| Max. Negotiated Rate |
$2,543.17 |
| Rate for Payer: Aetna Commercial |
$2,487.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,377.32
|
| Rate for Payer: Aetna Managed Medicare |
$774.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,796.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,382.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,326.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,465.09
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cigna Commercial |
$2,543.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,546.96
|
| Rate for Payer: Health EOS Commercial |
$2,460.24
|
| Rate for Payer: HFN Commercial |
$2,543.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,073.24
|
| Rate for Payer: Multiplan Commercial |
$2,211.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,658.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,543.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,354.52
|
| Rate for Payer: Quartz Commercial |
$1,796.81
|
| Rate for Payer: Quartz Medicare Advantage |
$1,658.59
|
| Rate for Payer: The Alliance Commercial |
$1,382.16
|
| Rate for Payer: WEA Trust Commercial |
$1,520.38
|
| Rate for Payer: WPS Commercial |
$2,047.46
|
|
|
KIT UROMAX DILATION 30FR X 4CM M0062251050
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
4595300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,354.52 |
| Max. Negotiated Rate |
$2,543.17 |
| Rate for Payer: Aetna Commercial |
$2,487.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,377.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,465.09
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cigna Commercial |
$2,543.17
|
| Rate for Payer: Health EOS Commercial |
$2,460.24
|
| Rate for Payer: HFN Commercial |
$2,543.17
|
| Rate for Payer: Multiplan Commercial |
$2,211.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,543.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,354.52
|
| Rate for Payer: Quartz Commercial |
$1,658.59
|
| Rate for Payer: WEA Trust Commercial |
$1,520.38
|
| Rate for Payer: WPS Commercial |
$2,047.46
|
|
|
KIT UROMAX DILATION 4MM X 4CM M0062251200
|
Facility
|
IP
|
$2,956.00
|
|
| Hospital Charge Code |
4520084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,506.38 |
| Max. Negotiated Rate |
$2,828.30 |
| Rate for Payer: Aetna Commercial |
$2,766.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,643.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,629.35
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cigna Commercial |
$2,828.30
|
| Rate for Payer: Health EOS Commercial |
$2,736.07
|
| Rate for Payer: HFN Commercial |
$2,828.30
|
| Rate for Payer: Multiplan Commercial |
$2,459.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,828.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,506.38
|
| Rate for Payer: Quartz Commercial |
$1,844.54
|
| Rate for Payer: WEA Trust Commercial |
$1,690.83
|
| Rate for Payer: WPS Commercial |
$2,277.01
|
|
|
KIT UROMAX DILATION 4MM X 4CM M0062251200
|
Facility
|
OP
|
$2,956.00
|
|
| Hospital Charge Code |
4520084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.79 |
| Max. Negotiated Rate |
$2,828.30 |
| Rate for Payer: Aetna Commercial |
$2,766.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,643.85
|
| Rate for Payer: Aetna Managed Medicare |
$860.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,998.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,537.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,475.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,629.35
|
| Rate for Payer: Cash Price |
$886.80
|
| Rate for Payer: Cigna Commercial |
$2,828.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,720.39
|
| Rate for Payer: Health EOS Commercial |
$2,736.07
|
| Rate for Payer: HFN Commercial |
$2,828.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,305.68
|
| Rate for Payer: Multiplan Commercial |
$2,459.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,844.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,828.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,506.38
|
| Rate for Payer: Quartz Commercial |
$1,998.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,844.54
|
| Rate for Payer: The Alliance Commercial |
$1,537.12
|
| Rate for Payer: WEA Trust Commercial |
$1,690.83
|
| Rate for Payer: WPS Commercial |
$2,277.01
|
|
|
KIT UROMAX DILATION 6MM X 4CM M0062251020
|
Facility
|
OP
|
$2,844.00
|
|
| Hospital Charge Code |
4520085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.17 |
| Max. Negotiated Rate |
$2,721.14 |
| Rate for Payer: Aetna Commercial |
$2,661.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.67
|
| Rate for Payer: Aetna Managed Medicare |
$828.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,922.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,478.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,419.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.61
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,721.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,655.21
|
| Rate for Payer: Health EOS Commercial |
$2,632.41
|
| Rate for Payer: HFN Commercial |
$2,721.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,218.32
|
| Rate for Payer: Multiplan Commercial |
$2,366.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,774.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,721.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.30
|
| Rate for Payer: Quartz Commercial |
$1,922.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,774.66
|
| Rate for Payer: The Alliance Commercial |
$1,478.88
|
| Rate for Payer: WEA Trust Commercial |
$1,626.77
|
| Rate for Payer: WPS Commercial |
$2,190.73
|
|
|
KIT UROMAX DILATION 6MM X 4CM M0062251020
|
Facility
|
IP
|
$2,844.00
|
|
| Hospital Charge Code |
4520085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,449.30 |
| Max. Negotiated Rate |
$2,721.14 |
| Rate for Payer: Aetna Commercial |
$2,661.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.61
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,721.14
|
| Rate for Payer: Health EOS Commercial |
$2,632.41
|
| Rate for Payer: HFN Commercial |
$2,721.14
|
| Rate for Payer: Multiplan Commercial |
$2,366.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,721.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.30
|
| Rate for Payer: Quartz Commercial |
$1,774.66
|
| Rate for Payer: WEA Trust Commercial |
$1,626.77
|
| Rate for Payer: WPS Commercial |
$2,190.73
|
|
|
KIT VTC NEPHROSTOMY 10fr M001271870
|
Facility
|
IP
|
$2,178.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2973047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,109.91 |
| Max. Negotiated Rate |
$2,083.91 |
| Rate for Payer: Aetna Commercial |
$2,038.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,200.51
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna Commercial |
$2,083.91
|
| Rate for Payer: Health EOS Commercial |
$2,015.96
|
| Rate for Payer: HFN Commercial |
$2,083.91
|
| Rate for Payer: Multiplan Commercial |
$1,812.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,083.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,109.91
|
| Rate for Payer: Quartz Commercial |
$1,359.07
|
| Rate for Payer: WEA Trust Commercial |
$1,245.82
|
| Rate for Payer: WPS Commercial |
$1,677.71
|
|
|
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 |
$634.23 |
| Max. Negotiated Rate |
$2,083.91 |
| Rate for Payer: Aetna Commercial |
$2,038.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.00
|
| Rate for Payer: Aetna Managed Medicare |
$634.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,472.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,132.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,200.51
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna Commercial |
$2,083.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,267.60
|
| Rate for Payer: Health EOS Commercial |
$2,015.96
|
| Rate for Payer: HFN Commercial |
$2,083.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,698.84
|
| Rate for Payer: Multiplan Commercial |
$1,812.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,083.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,109.91
|
| Rate for Payer: Quartz Commercial |
$1,472.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.07
|
| Rate for Payer: The Alliance Commercial |
$1,132.56
|
| Rate for Payer: WEA Trust Commercial |
$1,245.82
|
| Rate for Payer: WPS Commercial |
$1,677.71
|
|
|
KIT WOUND DRESSING PREVENA VAC 13CM PRE1101US
|
Facility
|
OP
|
$5,015.00
|
|
| Hospital Charge Code |
2974017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,460.37 |
| Max. Negotiated Rate |
$4,798.35 |
| Rate for Payer: Aetna Commercial |
$4,694.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,485.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,460.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,390.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,607.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,503.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,764.27
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$4,798.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,918.73
|
| Rate for Payer: Health EOS Commercial |
$4,641.88
|
| Rate for Payer: HFN Commercial |
$4,798.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,911.70
|
| Rate for Payer: Multiplan Commercial |
$4,172.48
|
| Rate for Payer: NAPHCARE Commercial |
$3,129.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,798.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,555.64
|
| Rate for Payer: Quartz Commercial |
$3,390.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,129.36
|
| Rate for Payer: The Alliance Commercial |
$2,607.80
|
| Rate for Payer: WEA Trust Commercial |
$2,868.58
|
| Rate for Payer: WPS Commercial |
$3,863.05
|
|
|
KIT WOUND DRESSING PREVENA VAC 13CM PRE1101US
|
Facility
|
IP
|
$5,015.00
|
|
| Hospital Charge Code |
2974017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,555.64 |
| Max. Negotiated Rate |
$4,798.35 |
| Rate for Payer: Aetna Commercial |
$4,694.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,485.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,764.27
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$4,798.35
|
| Rate for Payer: Health EOS Commercial |
$4,641.88
|
| Rate for Payer: HFN Commercial |
$4,798.35
|
| Rate for Payer: Multiplan Commercial |
$4,172.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,798.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,555.64
|
| Rate for Payer: Quartz Commercial |
$3,129.36
|
| Rate for Payer: WEA Trust Commercial |
$2,868.58
|
| Rate for Payer: WPS Commercial |
$3,863.05
|
|
|
KIT WOUND DRESSING PREVENA VAC 20CM PRE1001US
|
Facility
|
OP
|
$6,273.00
|
|
| Hospital Charge Code |
2975059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,826.70 |
| Max. Negotiated Rate |
$6,002.01 |
| Rate for Payer: Aetna Commercial |
$5,871.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,610.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,826.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,240.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,261.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,457.68
|
| Rate for Payer: Cash Price |
$1,881.90
|
| Rate for Payer: Cigna Commercial |
$6,002.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,650.89
|
| Rate for Payer: Health EOS Commercial |
$5,806.29
|
| Rate for Payer: HFN Commercial |
$6,002.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,892.94
|
| Rate for Payer: Multiplan Commercial |
$5,219.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,914.35
|
| Rate for Payer: Preferred Network Access Commercial |
$6,002.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,196.72
|
| Rate for Payer: Quartz Commercial |
$4,240.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,914.35
|
| Rate for Payer: The Alliance Commercial |
$3,261.96
|
| Rate for Payer: WEA Trust Commercial |
$3,588.16
|
| Rate for Payer: WPS Commercial |
$4,832.09
|
|
|
KIT WOUND DRESSING PREVENA VAC 20CM PRE1001US
|
Facility
|
IP
|
$6,273.00
|
|
| Hospital Charge Code |
2975059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,196.72 |
| Max. Negotiated Rate |
$6,002.01 |
| Rate for Payer: Aetna Commercial |
$5,871.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,610.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,457.68
|
| Rate for Payer: Cash Price |
$1,881.90
|
| Rate for Payer: Cigna Commercial |
$6,002.01
|
| Rate for Payer: Health EOS Commercial |
$5,806.29
|
| Rate for Payer: HFN Commercial |
$6,002.01
|
| Rate for Payer: Multiplan Commercial |
$5,219.14
|
| Rate for Payer: Preferred Network Access Commercial |
$6,002.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,196.72
|
| Rate for Payer: Quartz Commercial |
$3,914.35
|
| Rate for Payer: WEA Trust Commercial |
$3,588.16
|
| Rate for Payer: WPS Commercial |
$4,832.09
|
|
|
KIT WOUND DRESSING PREVENA VAC 35CM PRE3201US
|
Facility
|
IP
|
$5,937.00
|
|
| Hospital Charge Code |
5414738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,025.50 |
| Max. Negotiated Rate |
$5,680.52 |
| Rate for Payer: Aetna Commercial |
$5,557.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,310.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,272.47
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cigna Commercial |
$5,680.52
|
| Rate for Payer: Health EOS Commercial |
$5,495.29
|
| Rate for Payer: HFN Commercial |
$5,680.52
|
| Rate for Payer: Multiplan Commercial |
$4,939.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,680.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,025.50
|
| Rate for Payer: Quartz Commercial |
$3,704.69
|
| Rate for Payer: WEA Trust Commercial |
$3,395.96
|
| Rate for Payer: WPS Commercial |
$4,573.27
|
|
|
KIT WOUND DRESSING PREVENA VAC 35CM PRE3201US
|
Facility
|
OP
|
$5,937.00
|
|
| Hospital Charge Code |
5414738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,728.85 |
| Max. Negotiated Rate |
$5,680.52 |
| Rate for Payer: Aetna Commercial |
$5,557.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,310.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,728.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,013.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,087.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,963.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,272.47
|
| Rate for Payer: Cash Price |
$1,781.10
|
| Rate for Payer: Cigna Commercial |
$5,680.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,455.33
|
| Rate for Payer: Health EOS Commercial |
$5,495.29
|
| Rate for Payer: HFN Commercial |
$5,680.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,630.86
|
| Rate for Payer: Multiplan Commercial |
$4,939.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,704.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,680.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,025.50
|
| Rate for Payer: Quartz Commercial |
$4,013.41
|
| Rate for Payer: Quartz Medicare Advantage |
$3,704.69
|
| Rate for Payer: The Alliance Commercial |
$3,087.24
|
| Rate for Payer: WEA Trust Commercial |
$3,395.96
|
| Rate for Payer: WPS Commercial |
$4,573.27
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$16,572.11
|
|
|
Service Code
|
APR-DRG 3132
|
| Min. Negotiated Rate |
$14,720.38 |
| Max. Negotiated Rate |
$16,572.11 |
| Rate for Payer: Anthem Medicaid |
$15,868.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,868.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,868.70
|
| Rate for Payer: Dean Health Medicaid |
$15,868.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,720.38
|
| Rate for Payer: Managed Health Services Medicaid |
$16,572.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,868.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,868.70
|
| Rate for Payer: United Healthcare Medicaid |
$15,868.70
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$23,499.07
|
|
|
Service Code
|
APR-DRG 3133
|
| Min. Negotiated Rate |
$20,873.34 |
| Max. Negotiated Rate |
$23,499.07 |
| Rate for Payer: Anthem Medicaid |
$22,501.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,501.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,501.66
|
| Rate for Payer: Dean Health Medicaid |
$22,501.66
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,873.34
|
| Rate for Payer: Managed Health Services Medicaid |
$23,499.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,501.66
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,501.66
|
| Rate for Payer: United Healthcare Medicaid |
$22,501.66
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$12,451.00
|
|
|
Service Code
|
APR-DRG 3131
|
| Min. Negotiated Rate |
$11,059.76 |
| Max. Negotiated Rate |
$12,451.00 |
| Rate for Payer: Anthem Medicaid |
$11,922.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,922.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,922.52
|
| Rate for Payer: Dean Health Medicaid |
$11,922.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,059.76
|
| Rate for Payer: Managed Health Services Medicaid |
$12,451.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,922.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,922.52
|
| Rate for Payer: United Healthcare Medicaid |
$11,922.52
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$34,810.19
|
|
|
Service Code
|
APR-DRG 3134
|
| Min. Negotiated Rate |
$30,920.58 |
| Max. Negotiated Rate |
$34,810.19 |
| Rate for Payer: Anthem Medicaid |
$33,332.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,332.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,332.68
|
| Rate for Payer: Dean Health Medicaid |
$33,332.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,920.58
|
| Rate for Payer: Managed Health Services Medicaid |
$34,810.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,332.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,332.68
|
| Rate for Payer: United Healthcare Medicaid |
$33,332.68
|
|
|
KNEE ARTHROPLASTY, TOTAL
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
2960531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,870.34 |
| Max. Negotiated Rate |
$12,716.83 |
| Rate for Payer: Aetna Commercial |
$12,440.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,887.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,870.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,984.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,911.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,634.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,326.00
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,716.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,735.36
|
| Rate for Payer: Health EOS Commercial |
$12,302.15
|
| Rate for Payer: HFN Commercial |
$12,716.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,366.98
|
| Rate for Payer: Multiplan Commercial |
$11,058.11
|
| Rate for Payer: NAPHCARE Commercial |
$8,293.58
|
| Rate for Payer: Preferred Network Access Commercial |
$12,716.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,773.09
|
| Rate for Payer: Quartz Commercial |
$8,984.72
|
| Rate for Payer: Quartz Medicare Advantage |
$8,293.58
|
| Rate for Payer: The Alliance Commercial |
$6,911.32
|
| Rate for Payer: WEA Trust Commercial |
$7,602.45
|
| Rate for Payer: WPS Commercial |
$10,238.06
|
|
|
KNEE ARTHROPLASTY, TOTAL
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
2960531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,773.09 |
| Max. Negotiated Rate |
$12,716.83 |
| Rate for Payer: Aetna Commercial |
$12,440.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,887.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,326.00
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,716.83
|
| Rate for Payer: Health EOS Commercial |
$12,302.15
|
| Rate for Payer: HFN Commercial |
$12,716.83
|
| Rate for Payer: Multiplan Commercial |
$11,058.11
|
| Rate for Payer: Preferred Network Access Commercial |
$12,716.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,773.09
|
| Rate for Payer: Quartz Commercial |
$8,293.58
|
| Rate for Payer: WEA Trust Commercial |
$7,602.45
|
| Rate for Payer: WPS Commercial |
$10,238.06
|
|
