|
KNEE BRACE XL 5674-BLK-XL
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
3072382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$298.48 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$298.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.55
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$799.50
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$639.60
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
KNEE PATELLECTOMY
|
Facility
|
IP
|
$4,492.00
|
|
| Hospital Charge Code |
2960308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,289.12 |
| Max. Negotiated Rate |
$4,297.95 |
| Rate for Payer: Aetna Commercial |
$4,204.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,475.99
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,297.95
|
| Rate for Payer: Health EOS Commercial |
$4,157.80
|
| Rate for Payer: HFN Commercial |
$4,297.95
|
| Rate for Payer: Multiplan Commercial |
$3,737.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.12
|
| Rate for Payer: Quartz Commercial |
$2,803.01
|
| Rate for Payer: WEA Trust Commercial |
$2,569.42
|
| Rate for Payer: WPS Commercial |
$3,460.19
|
|
|
KNEE PATELLECTOMY
|
Facility
|
OP
|
$4,492.00
|
|
| Hospital Charge Code |
2960308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,308.07 |
| Max. Negotiated Rate |
$4,297.95 |
| Rate for Payer: Aetna Commercial |
$4,204.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,308.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,036.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,335.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,242.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,475.99
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,297.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,614.34
|
| Rate for Payer: Health EOS Commercial |
$4,157.80
|
| Rate for Payer: HFN Commercial |
$4,297.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,503.76
|
| Rate for Payer: Multiplan Commercial |
$3,737.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.12
|
| Rate for Payer: Quartz Commercial |
$3,036.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,803.01
|
| Rate for Payer: The Alliance Commercial |
$2,335.84
|
| Rate for Payer: WEA Trust Commercial |
$2,569.42
|
| Rate for Payer: WPS Commercial |
$3,460.19
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$58,579.04
|
|
|
Service Code
|
MSDRG 488
|
| Min. Negotiated Rate |
$14,053.36 |
| Max. Negotiated Rate |
$58,579.04 |
| Rate for Payer: Aetna Managed Medicare |
$14,053.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,243.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,481.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,208.66
|
| Rate for Payer: Anthem Medicare Advantage |
$14,053.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,053.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,053.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,053.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,873.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,053.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,721.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,053.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,053.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,053.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,053.36
|
| Rate for Payer: NAPHCARE Commercial |
$21,080.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14,053.36
|
| Rate for Payer: The Alliance Commercial |
$58,579.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,053.36
|
| Rate for Payer: United Healthcare PPO |
$33,259.50
|
| Rate for Payer: Wellcare Medicare |
$14,053.36
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$34,555.04
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$9,059.45 |
| Max. Negotiated Rate |
$34,555.04 |
| Rate for Payer: Aetna Managed Medicare |
$9,059.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,367.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,677.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,744.97
|
| Rate for Payer: Anthem Medicare Advantage |
$9,059.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,059.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,059.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,059.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,698.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,059.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,100.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,059.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,059.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,059.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,059.45
|
| Rate for Payer: NAPHCARE Commercial |
$13,589.18
|
| Rate for Payer: Quartz Medicare Advantage |
$9,059.45
|
| Rate for Payer: The Alliance Commercial |
$34,555.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,059.45
|
| Rate for Payer: United Healthcare PPO |
$19,541.10
|
| Rate for Payer: Wellcare Medicare |
$9,059.45
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$55,861.52
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$16,520.83 |
| Max. Negotiated Rate |
$55,861.52 |
| Rate for Payer: Aetna Managed Medicare |
$16,520.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,626.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,972.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,225.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16,520.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,520.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,520.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,520.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,883.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,520.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,728.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,520.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,520.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,520.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,520.83
|
| Rate for Payer: NAPHCARE Commercial |
$24,781.24
|
| Rate for Payer: Quartz Medicare Advantage |
$16,520.83
|
| Rate for Payer: The Alliance Commercial |
$55,861.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,520.83
|
| Rate for Payer: United Healthcare PPO |
$31,707.52
|
| Rate for Payer: Wellcare Medicare |
$16,520.83
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$91,410.80
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$25,220.55 |
| Max. Negotiated Rate |
$91,410.80 |
| Rate for Payer: Wellcare Medicare |
$25,220.55
|
| Rate for Payer: Aetna Managed Medicare |
$25,220.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,412.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,970.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,275.78
|
| Rate for Payer: Anthem Medicare Advantage |
$25,220.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,220.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,220.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,220.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,920.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,220.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66,802.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,220.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,220.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,220.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,220.55
|
| Rate for Payer: NAPHCARE Commercial |
$37,830.83
|
| Rate for Payer: Quartz Medicare Advantage |
$25,220.55
|
| Rate for Payer: The Alliance Commercial |
$91,410.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,220.55
|
| Rate for Payer: United Healthcare PPO |
$52,006.46
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$43,048.72
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$12,501.05 |
| Max. Negotiated Rate |
$43,048.72 |
| Rate for Payer: Aetna Managed Medicare |
$12,501.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,173.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,193.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,885.54
|
| Rate for Payer: Anthem Medicare Advantage |
$12,501.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,501.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,501.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,501.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,625.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,501.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,330.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,501.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,501.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,501.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,501.05
|
| Rate for Payer: NAPHCARE Commercial |
$18,751.57
|
| Rate for Payer: Quartz Medicare Advantage |
$12,501.05
|
| Rate for Payer: The Alliance Commercial |
$43,048.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,501.05
|
| Rate for Payer: United Healthcare PPO |
$24,391.26
|
| Rate for Payer: Wellcare Medicare |
$12,501.05
|
|
|
KNEE SUPPORT MED WITH OPEN PATELLA NE7702-73
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2974247
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
KNEE SUPPORT MED WITH OPEN PATELLA NE7702-73
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2974247
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
KNEE, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| 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: 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: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| 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 |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
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
|
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 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 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
|
|
