|
MANIFOLD MEDIFOLD 3-PORT MX7083CV
|
Facility
|
IP
|
$123.00
|
|
| Hospital Charge Code |
2969728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
MANIFOLD NEPTUNE 4 PORT 0700-040-000
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
2966091
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Aetna Managed Medicare |
$128.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.42
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$299.00
|
| Rate for Payer: Quartz Medicare Advantage |
$276.00
|
| Rate for Payer: The Alliance Commercial |
$1,840.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
MANIFOLD NEPTUNE 4 PORT 0700-040-000
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
2966091
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
MANIFOLD NEPTUNE 4-PORT 0702-020-000
|
Professional
|
Both
|
$491.00
|
|
| Hospital Charge Code |
4595080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.04 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Aetna Commercial |
$466.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$466.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.60
|
| Rate for Payer: Health EOS Commercial |
$446.81
|
| Rate for Payer: HFN Commercial |
$466.45
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Preferred Network Access Commercial |
$466.45
|
| Rate for Payer: Quartz Beloit One Network |
$216.04
|
| Rate for Payer: Quartz Commercial |
$279.87
|
| Rate for Payer: The Alliance Commercial |
$245.50
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
MANIFOLD NEPTUNE 4-PORT 0702-020-000
|
Facility
|
IP
|
$491.00
|
|
| Hospital Charge Code |
4595080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$451.72 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$294.60
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$294.60
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
MANIFOLD NEPTUNE 4-PORT 0702-020-000
|
Facility
|
OP
|
$491.00
|
|
| Hospital Charge Code |
4595080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.48 |
| Max. Negotiated Rate |
$1,964.00 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.76
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.25
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$294.60
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$319.15
|
| Rate for Payer: Quartz Medicare Advantage |
$294.60
|
| Rate for Payer: The Alliance Commercial |
$1,964.00
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
MANIFOLD NEPTUNE SINGLE PORT 0702-025-000
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
4595058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
MANIFOLD NEPTUNE SINGLE PORT 0702-025-000
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
4595058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
MANIFOLD NEPTUNE SINGLE PORT 0702-025-000
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
4595058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Maniplatn Palar Fascial Crd Post Inj 26341
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
4340593
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.77 |
| Max. Negotiated Rate |
$849.30 |
| Rate for Payer: Aetna Commercial |
$849.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$768.84
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cigna Commercial |
$849.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.40
|
| Rate for Payer: Health EOS Commercial |
$813.54
|
| Rate for Payer: HFN Commercial |
$849.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$258.33
|
| Rate for Payer: Multiplan Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$849.30
|
| Rate for Payer: Quartz Beloit One Network |
$393.36
|
| Rate for Payer: Quartz Commercial |
$509.58
|
| Rate for Payer: The Alliance Commercial |
$447.00
|
| Rate for Payer: United Healthcare Medicaid |
$74.77
|
| Rate for Payer: WEA Trust Commercial |
$491.70
|
| Rate for Payer: WPS Commercial |
$662.19
|
|
|
MANIPULATION, ANKLE/FOOT/HIP/KNEE/SHOULDER/WRIST
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
MANIPULATION, ANKLE/FOOT/HIP/KNEE/SHOULDER/WRIST
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
MANIPULATOR INJECTOR UTERINE KRONNER MANIPUJECTOR 6003
|
Facility
|
OP
|
$543.00
|
|
| Hospital Charge Code |
2964989
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.86
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
MANIPULATOR INJECTOR UTERINE KRONNER MANIPUJECTOR 6003
|
Facility
|
IP
|
$543.00
|
|
| Hospital Charge Code |
2964989
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
MANIPULATOR VCARE PLUS UTERINE LARGE CUP 37MM 60-6085-202A
|
Facility
|
IP
|
$2,129.00
|
|
| Hospital Charge Code |
5264652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,043.21 |
| Max. Negotiated Rate |
$1,958.68 |
| Rate for Payer: Aetna Commercial |
$1,916.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,128.37
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$1,958.68
|
| Rate for Payer: Health EOS Commercial |
$1,894.81
|
| Rate for Payer: HFN Commercial |
$1,958.68
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,277.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.21
|
| Rate for Payer: Quartz Commercial |
$1,277.40
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$1,576.95
|
|
|
MANIPULATOR VCARE PLUS UTERINE LARGE CUP 37MM 60-6085-202A
|
Facility
|
OP
|
$2,129.00
|
|
| Hospital Charge Code |
5264652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.12 |
| Max. Negotiated Rate |
$8,516.00 |
| Rate for Payer: Aetna Commercial |
$1,916.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Aetna Managed Medicare |
$596.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,383.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,064.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,021.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,128.37
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$1,958.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,191.39
|
| Rate for Payer: Health EOS Commercial |
$1,894.81
|
| Rate for Payer: HFN Commercial |
$1,958.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.75
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,277.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.21
|
| Rate for Payer: Quartz Commercial |
$1,383.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,277.40
|
| Rate for Payer: The Alliance Commercial |
$8,516.00
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$1,576.95
|
|
|
MANIPULATOR VCARE PLUS UTERINE MEDIUM CUP 34MM 60-6085-201A
|
Facility
|
OP
|
$2,129.00
|
|
| Hospital Charge Code |
5264651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.12 |
| Max. Negotiated Rate |
$8,516.00 |
| Rate for Payer: Aetna Commercial |
$1,916.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Aetna Managed Medicare |
$596.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,383.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,064.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,021.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,128.37
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$1,958.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,191.39
|
| Rate for Payer: Health EOS Commercial |
$1,894.81
|
| Rate for Payer: HFN Commercial |
$1,958.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.75
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,277.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.21
|
| Rate for Payer: Quartz Commercial |
$1,383.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,277.40
|
| Rate for Payer: The Alliance Commercial |
$8,516.00
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$1,576.95
|
|
|
MANIPULATOR VCARE PLUS UTERINE MEDIUM CUP 34MM 60-6085-201A
|
Facility
|
IP
|
$2,129.00
|
|
| Hospital Charge Code |
5264651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,043.21 |
| Max. Negotiated Rate |
$1,958.68 |
| Rate for Payer: Aetna Commercial |
$1,916.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,128.37
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$1,958.68
|
| Rate for Payer: Health EOS Commercial |
$1,894.81
|
| Rate for Payer: HFN Commercial |
$1,958.68
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,277.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.21
|
| Rate for Payer: Quartz Commercial |
$1,277.40
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$1,576.95
|
|
|
MANIPULATOR VCARE PLUS UTERINE SMALL CUP 32MM 60-6085-200A
|
Facility
|
IP
|
$2,129.00
|
|
| Hospital Charge Code |
5264650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,043.21 |
| Max. Negotiated Rate |
$1,958.68 |
| Rate for Payer: Aetna Commercial |
$1,916.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,128.37
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$1,958.68
|
| Rate for Payer: Health EOS Commercial |
$1,894.81
|
| Rate for Payer: HFN Commercial |
$1,958.68
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,277.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.21
|
| Rate for Payer: Quartz Commercial |
$1,277.40
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$1,576.95
|
|
|
MANIPULATOR VCARE PLUS UTERINE SMALL CUP 32MM 60-6085-200A
|
Facility
|
OP
|
$2,129.00
|
|
| Hospital Charge Code |
5264650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.12 |
| Max. Negotiated Rate |
$8,516.00 |
| Rate for Payer: Aetna Commercial |
$1,916.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Aetna Managed Medicare |
$596.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,383.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,064.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,021.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,128.37
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$1,958.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,191.39
|
| Rate for Payer: Health EOS Commercial |
$1,894.81
|
| Rate for Payer: HFN Commercial |
$1,958.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.75
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,277.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.21
|
| Rate for Payer: Quartz Commercial |
$1,383.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,277.40
|
| Rate for Payer: The Alliance Commercial |
$8,516.00
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$1,576.95
|
|
|
MANOMETER PRESSURE DISP #6098DPG
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
2974773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$44.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.42
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$102.70
|
| Rate for Payer: Quartz Medicare Advantage |
$94.80
|
| Rate for Payer: The Alliance Commercial |
$632.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
MANOMETER PRESSURE DISP #6098DPG
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
2974773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
.Manual Differential
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
983771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$3.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.31
|
| Rate for Payer: Anthem Medicaid |
$3.93
|
| Rate for Payer: Anthem Medicare Advantage |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.80
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicaid |
$3.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.80
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.80
|
| Rate for Payer: Managed Health Services Medicaid |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$5.70
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.93
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3.80
|
| Rate for Payer: The Alliance Commercial |
$15.20
|
| Rate for Payer: United Healthcare Medicaid |
$3.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.80
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$3.80
|
| Rate for Payer: WMAP Medicaid |
$3.93
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
