|
Marijuana Meconium
|
Professional
|
Both
|
$38.00
|
|
| Hospital Charge Code |
2942888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.71
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Marijuana Metabolites, GC/MS, Urine
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
983317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.97 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$225.26
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Marijuana Metabolites, GC/MS, Urine
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
983317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Aetna Managed Medicare |
$105.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$244.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.10
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: NAPHCARE Commercial |
$225.26
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$244.04
|
| Rate for Payer: Quartz Medicare Advantage |
$225.26
|
| Rate for Payer: The Alliance Commercial |
$187.72
|
| Rate for Payer: United Healthcare PPO |
$281.58
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Marijuana Metabolites, GC/MS, Urine
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
983317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$356.67 |
| Rate for Payer: Aetna Commercial |
$356.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$356.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.26
|
| Rate for Payer: Health EOS Commercial |
$341.65
|
| Rate for Payer: HFN Commercial |
$356.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: Preferred Network Access Commercial |
$356.67
|
| Rate for Payer: Quartz Beloit One Network |
$165.19
|
| Rate for Payer: Quartz Commercial |
$214.00
|
| Rate for Payer: The Alliance Commercial |
$187.72
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
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 |
$669.47 |
| Max. Negotiated Rate |
$2,199.68 |
| Rate for Payer: Aetna Commercial |
$2,151.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,056.23
|
| Rate for Payer: Aetna Managed Medicare |
$669.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,554.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,195.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,147.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,267.21
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,199.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,338.02
|
| Rate for Payer: Health EOS Commercial |
$2,127.95
|
| Rate for Payer: HFN Commercial |
$2,199.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,793.22
|
| Rate for Payer: Multiplan Commercial |
$1,912.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,434.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,199.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,171.57
|
| Rate for Payer: Quartz Commercial |
$1,554.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,434.58
|
| Rate for Payer: The Alliance Commercial |
$1,195.48
|
| Rate for Payer: WEA Trust Commercial |
$1,315.03
|
| Rate for Payer: WPS Commercial |
$1,770.92
|
|
|
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 |
$1,171.57 |
| Max. Negotiated Rate |
$2,199.68 |
| Rate for Payer: Aetna Commercial |
$2,151.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,056.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,267.21
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,199.68
|
| Rate for Payer: Health EOS Commercial |
$2,127.95
|
| Rate for Payer: HFN Commercial |
$2,199.68
|
| Rate for Payer: Multiplan Commercial |
$1,912.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,199.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,171.57
|
| Rate for Payer: Quartz Commercial |
$1,434.58
|
| Rate for Payer: WEA Trust Commercial |
$1,315.03
|
| Rate for Payer: WPS Commercial |
$1,770.92
|
|
|
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 |
$1,518.10 |
| Max. Negotiated Rate |
$2,850.31 |
| Rate for Payer: Aetna Commercial |
$2,788.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,664.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,642.02
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,850.31
|
| Rate for Payer: Health EOS Commercial |
$2,757.36
|
| Rate for Payer: HFN Commercial |
$2,850.31
|
| Rate for Payer: Multiplan Commercial |
$2,478.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,850.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,518.10
|
| Rate for Payer: Quartz Commercial |
$1,858.90
|
| Rate for Payer: WEA Trust Commercial |
$1,703.99
|
| Rate for Payer: WPS Commercial |
$2,294.72
|
|
|
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 |
$867.48 |
| Max. Negotiated Rate |
$2,850.31 |
| Rate for Payer: Aetna Commercial |
$2,788.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,664.42
|
| Rate for Payer: Aetna Managed Medicare |
$867.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,013.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,549.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,487.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,642.02
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,850.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,733.78
|
| Rate for Payer: Health EOS Commercial |
$2,757.36
|
| Rate for Payer: HFN Commercial |
$2,850.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,323.62
|
| Rate for Payer: Multiplan Commercial |
$2,478.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,858.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,850.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,518.10
|
| Rate for Payer: Quartz Commercial |
$2,013.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,858.90
|
| Rate for Payer: The Alliance Commercial |
$1,549.08
|
| Rate for Payer: WEA Trust Commercial |
$1,703.99
|
| Rate for Payer: WPS Commercial |
$2,294.72
|
|
|
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 |
$725.16 |
| Max. Negotiated Rate |
$1,361.53 |
| Rate for Payer: Aetna Commercial |
$1,331.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,272.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.36
|
| Rate for Payer: Cash Price |
$426.90
|
| Rate for Payer: Cigna Commercial |
$1,361.53
|
| Rate for Payer: Health EOS Commercial |
$1,317.13
|
| Rate for Payer: HFN Commercial |
$1,361.53
|
| Rate for Payer: Multiplan Commercial |
$1,183.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,361.53
|
| Rate for Payer: Quartz Beloit One Network |
$725.16
|
| Rate for Payer: Quartz Commercial |
$887.95
|
| Rate for Payer: WEA Trust Commercial |
$813.96
|
| Rate for Payer: WPS Commercial |
$1,096.14
|
|
|
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 |
$414.38 |
| Max. Negotiated Rate |
$1,361.53 |
| Rate for Payer: Aetna Commercial |
$1,331.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,272.73
|
| Rate for Payer: Aetna Managed Medicare |
$414.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$961.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$739.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.36
|
| Rate for Payer: Cash Price |
$426.90
|
| Rate for Payer: Cigna Commercial |
$1,361.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.19
|
| Rate for Payer: Health EOS Commercial |
$1,317.13
|
| Rate for Payer: HFN Commercial |
$1,361.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,109.94
|
| Rate for Payer: Multiplan Commercial |
$1,183.94
|
| Rate for Payer: NAPHCARE Commercial |
$887.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,361.53
|
| Rate for Payer: Quartz Beloit One Network |
$725.16
|
| Rate for Payer: Quartz Commercial |
$961.95
|
| Rate for Payer: Quartz Medicare Advantage |
$887.95
|
| Rate for Payer: The Alliance Commercial |
$739.96
|
| Rate for Payer: WEA Trust Commercial |
$813.96
|
| Rate for Payer: WPS Commercial |
$1,096.14
|
|
|
MARKER SURGICAL SKIN STD TIP WITH RULER DYNJSM01
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2963717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
MARKER SURGICAL SKIN STD TIP WITH RULER DYNJSM01
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2963717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
MARSHALL MARCHETTI KRANZ PROCEDURE (MMK)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960533
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
MARSHALL MARCHETTI KRANZ PROCEDURE (MMK)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960533
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
MASC COMPLETE KIT
|
Facility
|
IP
|
$1,634.00
|
|
| Hospital Charge Code |
2973438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$832.69 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,019.62
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
MASC COMPLETE KIT
|
Facility
|
OP
|
$1,634.00
|
|
| Hospital Charge Code |
2973438
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$475.82 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Aetna Managed Medicare |
$475.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,104.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$849.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$815.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$950.99
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.52
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,019.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,104.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,019.62
|
| Rate for Payer: The Alliance Commercial |
$849.68
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
MASK AIRWAY SIZE 3 SUPREME LMA ALBF030SU
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
5458826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$80.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$171.60
|
| Rate for Payer: The Alliance Commercial |
$143.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
MASK AIRWAY SIZE 3 SUPREME LMA ALBF030SU
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
5458826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
MASK AIRWAY SIZE 4 SUPREME LMA 175040
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2973069
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
MASK AIRWAY SIZE 4 SUPREME LMA 175040
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2973069
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
MASK AIRWAY SIZE 5 SUPREME LMA 175050
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2973070
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
MASK AIRWAY SIZE 5 SUPREME LMA 175050
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2973070
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
MASK ANESTHESIA UNSCENT SIZE 4 1045
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
2974641
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$39.94
|
| Rate for Payer: The Alliance Commercial |
$33.28
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
MASK ANESTHESIA UNSCENT SIZE 4 1045
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
2974641
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
MASK BI-LEVEL MEDIUM VERA VENT #1012637
|
Facility
|
OP
|
$567.00
|
|
| Hospital Charge Code |
2974496
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$165.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$353.81
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$353.81
|
| Rate for Payer: The Alliance Commercial |
$294.84
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
