|
KNEE, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
KNIFE 2.4 SLIT CLEARCUT 8065982465
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
2964174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Aetna Managed Medicare |
$161.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.85
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.34
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: NAPHCARE Commercial |
$345.07
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$373.83
|
| Rate for Payer: Quartz Medicare Advantage |
$345.07
|
| Rate for Payer: The Alliance Commercial |
$287.56
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
KNIFE 2.4 SLIT CLEARCUT 8065982465
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
2964174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.81 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$345.07
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
KNIFE 2.5 ANGLED SLIT E7550A
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2964766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
KNIFE 2.5 ANGLED SLIT E7550A
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2964766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
KNIFE 2.65 STRAIGHT SLIT 622-00W5441-06
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
2967393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$60.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.47
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.46
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$129.17
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$139.93
|
| Rate for Payer: Quartz Medicare Advantage |
$129.17
|
| Rate for Payer: The Alliance Commercial |
$107.64
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
KNIFE 2.65 STRAIGHT SLIT 622-00W5441-06
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
2967393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$129.17
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
KNIFE 3.5 ANG SHORT CUT 8065993561
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
2964175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$96.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.74
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$207.79
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$207.79
|
| Rate for Payer: The Alliance Commercial |
$173.16
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
KNIFE 3.5 ANG SHORT CUT 8065993561
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
2964175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
KNIFE 4.1 ANG SHORT CUT 8065994061
|
Facility
|
OP
|
$474.00
|
|
| Hospital Charge Code |
6065629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.03 |
| Max. Negotiated Rate |
$453.52 |
| Rate for Payer: Aetna Commercial |
$443.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.95
|
| Rate for Payer: Aetna Managed Medicare |
$138.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.27
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$453.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.87
|
| Rate for Payer: Health EOS Commercial |
$438.73
|
| Rate for Payer: HFN Commercial |
$453.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.72
|
| Rate for Payer: Multiplan Commercial |
$394.37
|
| Rate for Payer: NAPHCARE Commercial |
$295.78
|
| Rate for Payer: Preferred Network Access Commercial |
$453.52
|
| Rate for Payer: Quartz Beloit One Network |
$241.55
|
| Rate for Payer: Quartz Commercial |
$320.42
|
| Rate for Payer: Quartz Medicare Advantage |
$295.78
|
| Rate for Payer: The Alliance Commercial |
$246.48
|
| Rate for Payer: WEA Trust Commercial |
$271.13
|
| Rate for Payer: WPS Commercial |
$365.12
|
|
|
KNIFE 4.1 ANG SHORT CUT 8065994061
|
Facility
|
IP
|
$474.00
|
|
| Hospital Charge Code |
6065629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.55 |
| Max. Negotiated Rate |
$453.52 |
| Rate for Payer: Aetna Commercial |
$443.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.27
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$453.52
|
| Rate for Payer: Health EOS Commercial |
$438.73
|
| Rate for Payer: HFN Commercial |
$453.52
|
| Rate for Payer: Multiplan Commercial |
$394.37
|
| Rate for Payer: Preferred Network Access Commercial |
$453.52
|
| Rate for Payer: Quartz Beloit One Network |
$241.55
|
| Rate for Payer: Quartz Commercial |
$295.78
|
| Rate for Payer: WEA Trust Commercial |
$271.13
|
| Rate for Payer: WPS Commercial |
$365.12
|
|
|
KNIFE CRESCENT ANG 8065-990002
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
2964176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
KNIFE CRESCENT ANG 8065-990002
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
2964176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$96.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.74
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$207.79
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$207.79
|
| Rate for Payer: The Alliance Commercial |
$173.16
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
KNIFE MICROSURGICAL BAYONET
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2965956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Aetna Managed Medicare |
$373.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.54
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.18
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: NAPHCARE Commercial |
$799.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$865.96
|
| Rate for Payer: Quartz Medicare Advantage |
$799.34
|
| Rate for Payer: The Alliance Commercial |
$666.12
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
KNIFE MICROSURGICAL BAYONET
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2965956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.80 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$799.34
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
KNIFE MICROSURGICAL STRAIGHT
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2965957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Aetna Managed Medicare |
$373.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.54
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.18
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: NAPHCARE Commercial |
$799.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$865.96
|
| Rate for Payer: Quartz Medicare Advantage |
$799.34
|
| Rate for Payer: The Alliance Commercial |
$666.12
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
KNIFE MICROSURGICAL STRAIGHT
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2965957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.80 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$799.34
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
KNIFE RETRACTABLE CANNULATED STRAIGHT AR-6527-01
|
Facility
|
OP
|
$3,043.00
|
|
| Hospital Charge Code |
4509017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.12 |
| Max. Negotiated Rate |
$2,911.54 |
| Rate for Payer: Aetna Commercial |
$2,848.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,721.66
|
| Rate for Payer: Aetna Managed Medicare |
$886.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,582.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.30
|
| Rate for Payer: Cash Price |
$912.90
|
| Rate for Payer: Cigna Commercial |
$2,911.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,771.03
|
| Rate for Payer: Health EOS Commercial |
$2,816.60
|
| Rate for Payer: HFN Commercial |
$2,911.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,373.54
|
| Rate for Payer: Multiplan Commercial |
$2,531.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,898.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,911.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,550.71
|
| Rate for Payer: Quartz Commercial |
$2,057.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,898.83
|
| Rate for Payer: The Alliance Commercial |
$1,582.36
|
| Rate for Payer: WEA Trust Commercial |
$1,740.60
|
| Rate for Payer: WPS Commercial |
$2,344.02
|
|
|
KNIFE RETRACTABLE CANNULATED STRAIGHT AR-6527-01
|
Facility
|
IP
|
$3,043.00
|
|
| Hospital Charge Code |
4509017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,550.71 |
| Max. Negotiated Rate |
$2,911.54 |
| Rate for Payer: Aetna Commercial |
$2,848.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,721.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.30
|
| Rate for Payer: Cash Price |
$912.90
|
| Rate for Payer: Cigna Commercial |
$2,911.54
|
| Rate for Payer: Health EOS Commercial |
$2,816.60
|
| Rate for Payer: HFN Commercial |
$2,911.54
|
| Rate for Payer: Multiplan Commercial |
$2,531.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,911.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,550.71
|
| Rate for Payer: Quartz Commercial |
$1,898.83
|
| Rate for Payer: WEA Trust Commercial |
$1,740.60
|
| Rate for Payer: WPS Commercial |
$2,344.02
|
|
|
KNIFE RX NEEDLE 4584
|
Facility
|
IP
|
$2,670.00
|
|
| Hospital Charge Code |
2973085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,360.63 |
| Max. Negotiated Rate |
$2,554.66 |
| Rate for Payer: Aetna Commercial |
$2,499.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.70
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,554.66
|
| Rate for Payer: Health EOS Commercial |
$2,471.35
|
| Rate for Payer: HFN Commercial |
$2,554.66
|
| Rate for Payer: Multiplan Commercial |
$2,221.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.63
|
| Rate for Payer: Quartz Commercial |
$1,666.08
|
| Rate for Payer: WEA Trust Commercial |
$1,527.24
|
| Rate for Payer: WPS Commercial |
$2,056.70
|
|
|
KNIFE RX NEEDLE 4584
|
Facility
|
OP
|
$2,670.00
|
|
| Hospital Charge Code |
2973085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.50 |
| Max. Negotiated Rate |
$2,554.66 |
| Rate for Payer: Aetna Commercial |
$2,499.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.05
|
| Rate for Payer: Aetna Managed Medicare |
$777.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,804.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,388.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.70
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,554.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,553.94
|
| Rate for Payer: Health EOS Commercial |
$2,471.35
|
| Rate for Payer: HFN Commercial |
$2,554.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,082.60
|
| Rate for Payer: Multiplan Commercial |
$2,221.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.63
|
| Rate for Payer: Quartz Commercial |
$1,804.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,666.08
|
| Rate for Payer: The Alliance Commercial |
$1,388.40
|
| Rate for Payer: WEA Trust Commercial |
$1,527.24
|
| Rate for Payer: WPS Commercial |
$2,056.70
|
|
|
KNIFE SIDEPORT CLEARCUT 1.0 8065921540
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
2964173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.81 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$345.07
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
KNIFE SIDEPORT CLEARCUT 1.0 8065921540
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
2964173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Aetna Managed Medicare |
$161.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.85
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.34
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: NAPHCARE Commercial |
$345.07
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$373.83
|
| Rate for Payer: Quartz Medicare Advantage |
$345.07
|
| Rate for Payer: The Alliance Commercial |
$287.56
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
KNIFE WITH HANDLE MYRINGOTOMY SPEAR DISP 7013-0791
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2965125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
KNIFE WITH HANDLE MYRINGOTOMY SPEAR DISP 7013-0791
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2965125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
