|
Marfan and Related Genetic Panel to Mayo
|
Facility
|
IP
|
$4,404.00
|
|
|
Service Code
|
CPT 81410
|
| Hospital Charge Code |
5322768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,157.96 |
| Max. Negotiated Rate |
$4,051.68 |
| Rate for Payer: Aetna Commercial |
$3,963.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.12
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,051.68
|
| Rate for Payer: Health EOS Commercial |
$3,919.56
|
| Rate for Payer: HFN Commercial |
$4,051.68
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,642.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,051.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.96
|
| Rate for Payer: Quartz Commercial |
$2,642.40
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
|
Marijuana Meconium
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2942888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Marijuana Meconium
|
Professional
|
Both
|
$38.00
|
|
| Hospital Charge Code |
2942888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.80
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: HFN Commercial |
$36.10
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Marijuana Meconium
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2942888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Marijuana Metabolites, GC/MS, Urine
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
983317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.08 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Aetna Managed Medicare |
$101.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$234.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.02
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$234.65
|
| Rate for Payer: Quartz Medicare Advantage |
$216.60
|
| Rate for Payer: The Alliance Commercial |
$1,444.00
|
| Rate for Payer: United Healthcare PPO |
$270.75
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
Marijuana Metabolites, GC/MS, Urine
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
983317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$332.12 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$216.60
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
Marijuana Metabolites, GC/MS, Urine
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
983317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: WPS Commercial |
$267.39
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: Aetna Commercial |
$342.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$342.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.60
|
| Rate for Payer: Health EOS Commercial |
$328.51
|
| Rate for Payer: HFN Commercial |
$342.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: Preferred Network Access Commercial |
$342.95
|
| Rate for Payer: Quartz Beloit One Network |
$158.84
|
| Rate for Payer: Quartz Commercial |
$205.77
|
| Rate for Payer: The Alliance Commercial |
$180.50
|
|
|
MARKER FIDUCIAL GOLD 1.2X5.0MM 17G X 30CM NEEDLE 3-PK GF1533
|
Facility
|
IP
|
$2,299.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5459004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.51 |
| Max. Negotiated Rate |
$2,115.08 |
| Rate for Payer: Aetna Commercial |
$2,069.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,977.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,218.47
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,115.08
|
| Rate for Payer: Health EOS Commercial |
$2,046.11
|
| Rate for Payer: HFN Commercial |
$2,115.08
|
| Rate for Payer: Multiplan Commercial |
$1,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,379.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,115.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.51
|
| Rate for Payer: Quartz Commercial |
$1,379.40
|
| Rate for Payer: WEA Trust Commercial |
$1,264.45
|
| Rate for Payer: WPS Commercial |
$1,702.87
|
|
|
MARKER FIDUCIAL GOLD 1.2X5.0MM 17G X 30CM NEEDLE 3-PK GF1533
|
Facility
|
OP
|
$2,299.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5459004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.72 |
| Max. Negotiated Rate |
$9,196.00 |
| Rate for Payer: Aetna Commercial |
$2,069.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,977.14
|
| Rate for Payer: Aetna Managed Medicare |
$643.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,494.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,218.47
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,115.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,286.52
|
| Rate for Payer: Health EOS Commercial |
$2,046.11
|
| Rate for Payer: HFN Commercial |
$2,115.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,724.25
|
| Rate for Payer: Multiplan Commercial |
$1,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,379.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,115.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.51
|
| Rate for Payer: Quartz Commercial |
$1,494.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,379.40
|
| Rate for Payer: The Alliance Commercial |
$9,196.00
|
| Rate for Payer: WEA Trust Commercial |
$1,264.45
|
| Rate for Payer: WPS Commercial |
$1,702.87
|
|
|
MARKER FIDUCIAL POLYMARK 0.8X3MM (POUCH OF 4) MTCTXPM0834
|
Facility
|
IP
|
$2,979.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5591365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,459.71 |
| Max. Negotiated Rate |
$2,740.68 |
| Rate for Payer: Aetna Commercial |
$2,681.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,561.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,578.87
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,740.68
|
| Rate for Payer: Health EOS Commercial |
$2,651.31
|
| Rate for Payer: HFN Commercial |
$2,740.68
|
| Rate for Payer: Multiplan Commercial |
$2,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,787.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,740.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,459.71
|
| Rate for Payer: Quartz Commercial |
$1,787.40
|
| Rate for Payer: WEA Trust Commercial |
$1,638.45
|
| Rate for Payer: WPS Commercial |
$2,206.55
|
|
|
MARKER FIDUCIAL POLYMARK 0.8X3MM (POUCH OF 4) MTCTXPM0834
|
Facility
|
OP
|
$2,979.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5591365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$834.12 |
| Max. Negotiated Rate |
$11,916.00 |
| Rate for Payer: Aetna Commercial |
$2,681.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,561.94
|
| Rate for Payer: Aetna Managed Medicare |
$834.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,936.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,489.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,429.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,578.87
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,740.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,667.05
|
| Rate for Payer: Health EOS Commercial |
$2,651.31
|
| Rate for Payer: HFN Commercial |
$2,740.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,234.25
|
| Rate for Payer: Multiplan Commercial |
$2,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,787.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,740.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,459.71
|
| Rate for Payer: Quartz Commercial |
$1,936.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,787.40
|
| Rate for Payer: The Alliance Commercial |
$11,916.00
|
| Rate for Payer: WEA Trust Commercial |
$1,638.45
|
| Rate for Payer: WPS Commercial |
$2,206.55
|
|
|
MARKER FIDUCIAL POLYMARK 1X3MM 18G X 25CM NEEDLE (POUCH OF 1) PM-1.0-3-18-25
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5591364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.27 |
| Max. Negotiated Rate |
$1,309.16 |
| Rate for Payer: Aetna Commercial |
$1,280.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,223.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.19
|
| Rate for Payer: Cash Price |
$426.90
|
| Rate for Payer: Cigna Commercial |
$1,309.16
|
| Rate for Payer: Health EOS Commercial |
$1,266.47
|
| Rate for Payer: HFN Commercial |
$1,309.16
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: NAPHCARE Commercial |
$853.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,309.16
|
| Rate for Payer: Quartz Beloit One Network |
$697.27
|
| Rate for Payer: Quartz Commercial |
$853.80
|
| Rate for Payer: WEA Trust Commercial |
$782.65
|
| Rate for Payer: WPS Commercial |
$1,054.02
|
|
|
MARKER FIDUCIAL POLYMARK 1X3MM 18G X 25CM NEEDLE (POUCH OF 1) PM-1.0-3-18-25
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5591364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.44 |
| Max. Negotiated Rate |
$5,692.00 |
| Rate for Payer: Aetna Commercial |
$1,280.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,223.78
|
| Rate for Payer: Aetna Managed Medicare |
$398.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$924.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$711.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.19
|
| Rate for Payer: Cash Price |
$426.90
|
| Rate for Payer: Cigna Commercial |
$1,309.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.31
|
| Rate for Payer: Health EOS Commercial |
$1,266.47
|
| Rate for Payer: HFN Commercial |
$1,309.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,067.25
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: NAPHCARE Commercial |
$853.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,309.16
|
| Rate for Payer: Quartz Beloit One Network |
$697.27
|
| Rate for Payer: Quartz Commercial |
$924.95
|
| Rate for Payer: Quartz Medicare Advantage |
$853.80
|
| Rate for Payer: The Alliance Commercial |
$5,692.00
|
| Rate for Payer: WEA Trust Commercial |
$782.65
|
| Rate for Payer: WPS Commercial |
$1,054.02
|
|
|
MARKER SURGICAL SKIN STD TIP WITH RULER DYNJSM01
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2963717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
MARKER SURGICAL SKIN STD TIP WITH RULER DYNJSM01
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2963717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
MARSHALL MARCHETTI KRANZ PROCEDURE (MMK)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960533
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
MARSHALL MARCHETTI KRANZ PROCEDURE (MMK)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960533
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
MASC COMPLETE KIT
|
Facility
|
OP
|
$1,634.00
|
|
| Hospital Charge Code |
2973438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$457.52 |
| Max. Negotiated Rate |
$6,536.00 |
| Rate for Payer: Aetna Commercial |
$1,470.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.24
|
| Rate for Payer: Aetna Managed Medicare |
$457.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,062.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$817.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$784.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$866.02
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,503.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.39
|
| Rate for Payer: Health EOS Commercial |
$1,454.26
|
| Rate for Payer: HFN Commercial |
$1,503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.50
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$980.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.28
|
| Rate for Payer: Quartz Beloit One Network |
$800.66
|
| Rate for Payer: Quartz Commercial |
$1,062.10
|
| Rate for Payer: Quartz Medicare Advantage |
$980.40
|
| Rate for Payer: The Alliance Commercial |
$6,536.00
|
| Rate for Payer: WEA Trust Commercial |
$898.70
|
| Rate for Payer: WPS Commercial |
$1,210.30
|
|
|
MASC COMPLETE KIT
|
Facility
|
IP
|
$1,634.00
|
|
| Hospital Charge Code |
2973438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$800.66 |
| Max. Negotiated Rate |
$1,503.28 |
| Rate for Payer: Aetna Commercial |
$1,470.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$866.02
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,503.28
|
| Rate for Payer: Health EOS Commercial |
$1,454.26
|
| Rate for Payer: HFN Commercial |
$1,503.28
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$980.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.28
|
| Rate for Payer: Quartz Beloit One Network |
$800.66
|
| Rate for Payer: Quartz Commercial |
$980.40
|
| Rate for Payer: WEA Trust Commercial |
$898.70
|
| Rate for Payer: WPS Commercial |
$1,210.30
|
|
|
MASK AIRWAY SIZE 3 SUPREME LMA ALBF030SU
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
5458826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$77.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.89
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$165.00
|
| Rate for Payer: The Alliance Commercial |
$1,100.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
MASK AIRWAY SIZE 3 SUPREME LMA ALBF030SU
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
5458826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
MASK AIRWAY SIZE 4 SUPREME LMA 175040
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2973069
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
MASK AIRWAY SIZE 4 SUPREME LMA 175040
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2973069
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
MASK AIRWAY SIZE 5 SUPREME LMA 175050
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2973070
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
MASK AIRWAY SIZE 5 SUPREME LMA 175050
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2973070
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
