|
MASK BI-LEVEL MEDIUM VERA VENT #1012637
|
Facility
|
IP
|
$567.00
|
|
| Hospital Charge Code |
2974496
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| 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: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
MASK FULL FACE LARGE #1012638
|
Facility
|
OP
|
$567.00
|
|
| Hospital Charge Code |
2974497
|
|
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
|
|
|
MASK FULL FACE LARGE #1012638
|
Facility
|
IP
|
$567.00
|
|
| Hospital Charge Code |
2974497
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| 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: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
MASK FULL FACE SMALL VENT #1012636
|
Facility
|
IP
|
$567.00
|
|
| Hospital Charge Code |
2974495
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| 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: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
MASK FULL FACE SMALL VENT #1012636
|
Facility
|
OP
|
$567.00
|
|
| Hospital Charge Code |
2974495
|
|
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
|
|
|
MASK N95 ORANGE DUCKBILL KC SMALL 46827
|
Facility
|
OP
|
$456.00
|
|
| Hospital Charge Code |
2969087
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Aetna Managed Medicare |
$132.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.39
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.68
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: NAPHCARE Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: Quartz Medicare Advantage |
$284.54
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
MASK N95 ORANGE DUCKBILL KC SMALL 46827
|
Facility
|
IP
|
$456.00
|
|
| Hospital Charge Code |
2969087
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
MASK PANDA MEDIUM 1293
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
2969776
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
MASK PANDA MEDIUM 1293
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
2969776
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$49.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.94
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$106.08
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$106.08
|
| Rate for Payer: The Alliance Commercial |
$88.40
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
MASK PANDA SMALL HUD100110S
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
2969777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$49.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.94
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$106.08
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$106.08
|
| Rate for Payer: The Alliance Commercial |
$88.40
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
MASK PANDA SMALL HUD100110S
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
2969777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
MASK PED HIGH CONCENTR #1000
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2974751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
MASK PED HIGH CONCENTR #1000
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2974751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
MASK PROCEDURE FLUID SHIELD ORANGE 47107
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
2963481
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
MASK PROCEDURE FLUID SHIELD ORANGE 47107
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
2963481
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
MASSAGE CREME 1 GAL BIOTONE #9283-14
|
Facility
|
OP
|
$1,262.00
|
|
| Hospital Charge Code |
2969712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$367.49 |
| Max. Negotiated Rate |
$1,207.48 |
| Rate for Payer: Aetna Commercial |
$1,181.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.73
|
| Rate for Payer: Aetna Managed Medicare |
$367.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$853.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$656.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$629.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$695.61
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,207.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$734.48
|
| Rate for Payer: Health EOS Commercial |
$1,168.11
|
| Rate for Payer: HFN Commercial |
$1,207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$984.36
|
| Rate for Payer: Multiplan Commercial |
$1,049.98
|
| Rate for Payer: NAPHCARE Commercial |
$787.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,207.48
|
| Rate for Payer: Quartz Beloit One Network |
$643.12
|
| Rate for Payer: Quartz Commercial |
$853.11
|
| Rate for Payer: Quartz Medicare Advantage |
$787.49
|
| Rate for Payer: The Alliance Commercial |
$656.24
|
| Rate for Payer: WEA Trust Commercial |
$721.86
|
| Rate for Payer: WPS Commercial |
$972.12
|
|
|
MASSAGE CREME 1 GAL BIOTONE #9283-14
|
Facility
|
IP
|
$1,262.00
|
|
| Hospital Charge Code |
2969712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$643.12 |
| Max. Negotiated Rate |
$1,207.48 |
| Rate for Payer: Aetna Commercial |
$1,181.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$695.61
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,207.48
|
| Rate for Payer: Health EOS Commercial |
$1,168.11
|
| Rate for Payer: HFN Commercial |
$1,207.48
|
| Rate for Payer: Multiplan Commercial |
$1,049.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,207.48
|
| Rate for Payer: Quartz Beloit One Network |
$643.12
|
| Rate for Payer: Quartz Commercial |
$787.49
|
| Rate for Payer: WEA Trust Commercial |
$721.86
|
| Rate for Payer: WPS Commercial |
$972.12
|
|
|
MASSAGE CREME & LOTION 1 GAL #9283-16
|
Facility
|
IP
|
$850.00
|
|
| Hospital Charge Code |
2974061
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$433.16 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$468.52
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$813.28
|
| Rate for Payer: Health EOS Commercial |
$786.76
|
| Rate for Payer: HFN Commercial |
$813.28
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: Preferred Network Access Commercial |
$813.28
|
| Rate for Payer: Quartz Beloit One Network |
$433.16
|
| Rate for Payer: Quartz Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.75
|
|
|
MASSAGE CREME & LOTION 1 GAL #9283-16
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
2974061
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$247.52 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Aetna Managed Medicare |
$247.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$574.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$468.52
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$813.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.70
|
| Rate for Payer: Health EOS Commercial |
$786.76
|
| Rate for Payer: HFN Commercial |
$813.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: NAPHCARE Commercial |
$530.40
|
| Rate for Payer: Preferred Network Access Commercial |
$813.28
|
| Rate for Payer: Quartz Beloit One Network |
$433.16
|
| Rate for Payer: Quartz Commercial |
$574.60
|
| Rate for Payer: Quartz Medicare Advantage |
$530.40
|
| Rate for Payer: The Alliance Commercial |
$442.00
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.75
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$48,479.60
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$15,261.06 |
| Max. Negotiated Rate |
$48,479.60 |
| Rate for Payer: Aetna Managed Medicare |
$15,261.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,036.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,220.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,611.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15,261.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,261.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,261.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,261.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,982.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,261.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,808.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,261.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,261.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,261.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,261.06
|
| Rate for Payer: NAPHCARE Commercial |
$22,891.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,261.06
|
| Rate for Payer: The Alliance Commercial |
$48,479.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,261.06
|
| Rate for Payer: United Healthcare PPO |
$26,320.58
|
| Rate for Payer: Wellcare Medicare |
$15,261.06
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$42,413.28
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$13,712.58 |
| Max. Negotiated Rate |
$42,413.28 |
| Rate for Payer: Aetna Managed Medicare |
$13,712.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,625.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,839.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,399.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,712.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,712.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,712.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,712.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,415.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,712.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,864.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,712.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,712.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,712.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,712.58
|
| Rate for Payer: NAPHCARE Commercial |
$20,568.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13,712.58
|
| Rate for Payer: The Alliance Commercial |
$42,413.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,712.58
|
| Rate for Payer: United Healthcare PPO |
$24,028.12
|
| Rate for Payer: Wellcare Medicare |
$13,712.58
|
|
|
MASTECTOMY, MODIFIED RADICAL
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
MASTECTOMY, MODIFIED RADICAL
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE
|
Facility
|
OP
|
$27,952.16
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,400.16 |
| Max. Negotiated Rate |
$27,952.16 |
| Rate for Payer: Aetna Managed Medicare |
$6,988.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$6,988.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,988.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,988.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,988.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,988.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,995.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,988.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,988.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,988.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,988.04
|
| Rate for Payer: NAPHCARE Commercial |
$10,482.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6,988.04
|
| Rate for Payer: The Alliance Commercial |
$27,952.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,988.04
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$6,988.04
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
|
Facility
|
OP
|
$16,482.25
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,120.56 |
| Max. Negotiated Rate |
$16,482.25 |
| Rate for Payer: Aetna Managed Medicare |
$4,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$4,120.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,120.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,328.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,120.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,120.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,120.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,120.56
|
| Rate for Payer: NAPHCARE Commercial |
$6,180.84
|
| Rate for Payer: Quartz Medicare Advantage |
$4,120.56
|
| Rate for Payer: The Alliance Commercial |
$16,482.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,120.56
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$4,120.56
|
|
