|
MESH VENTRALIGHT ECHO 6 X 8 (15X20CM) 5955680
|
Facility
|
OP
|
$8,551.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4640731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,394.28 |
| Max. Negotiated Rate |
$34,204.00 |
| Rate for Payer: Aetna Commercial |
$7,695.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,353.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,394.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,558.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.03
|
| Rate for Payer: Cash Price |
$2,565.30
|
| Rate for Payer: Cigna Commercial |
$7,866.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,785.14
|
| Rate for Payer: Health EOS Commercial |
$7,610.39
|
| Rate for Payer: HFN Commercial |
$7,866.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,413.25
|
| Rate for Payer: Multiplan Commercial |
$6,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,130.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,866.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.99
|
| Rate for Payer: Quartz Commercial |
$5,558.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,130.60
|
| Rate for Payer: The Alliance Commercial |
$34,204.00
|
| Rate for Payer: WEA Trust Commercial |
$4,703.05
|
| Rate for Payer: WPS Commercial |
$6,333.73
|
|
|
MESH VENTRALIGHT ECHO 6 X 8 (15X20CM) 5955680
|
Facility
|
IP
|
$8,551.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4640731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,189.99 |
| Max. Negotiated Rate |
$7,866.92 |
| Rate for Payer: Aetna Commercial |
$7,695.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,353.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.03
|
| Rate for Payer: Cash Price |
$2,565.30
|
| Rate for Payer: Cigna Commercial |
$7,866.92
|
| Rate for Payer: Health EOS Commercial |
$7,610.39
|
| Rate for Payer: HFN Commercial |
$7,866.92
|
| Rate for Payer: Multiplan Commercial |
$6,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,130.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,866.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.99
|
| Rate for Payer: Quartz Commercial |
$5,130.60
|
| Rate for Payer: WEA Trust Commercial |
$4,703.05
|
| Rate for Payer: WPS Commercial |
$6,333.73
|
|
|
MESH VENTRALIGHT ECHO 8 x 10 IN (20X25CM) 5955810
|
Facility
|
OP
|
$13,680.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,830.40 |
| Max. Negotiated Rate |
$54,720.00 |
| Rate for Payer: Aetna Commercial |
$12,312.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,764.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,830.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,892.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,840.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,566.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,250.40
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna Commercial |
$12,585.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,655.33
|
| Rate for Payer: Health EOS Commercial |
$12,175.20
|
| Rate for Payer: HFN Commercial |
$12,585.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,260.00
|
| Rate for Payer: Multiplan Commercial |
$10,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,585.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,703.20
|
| Rate for Payer: Quartz Commercial |
$8,892.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,208.00
|
| Rate for Payer: The Alliance Commercial |
$54,720.00
|
| Rate for Payer: WEA Trust Commercial |
$7,524.00
|
| Rate for Payer: WPS Commercial |
$10,132.78
|
|
|
MESH VENTRALIGHT ECHO 8 x 10 IN (20X25CM) 5955810
|
Facility
|
IP
|
$13,680.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,703.20 |
| Max. Negotiated Rate |
$12,585.60 |
| Rate for Payer: Aetna Commercial |
$12,312.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,764.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,250.40
|
| Rate for Payer: Cash Price |
$4,104.00
|
| Rate for Payer: Cigna Commercial |
$12,585.60
|
| Rate for Payer: Health EOS Commercial |
$12,175.20
|
| Rate for Payer: HFN Commercial |
$12,585.60
|
| Rate for Payer: Multiplan Commercial |
$10,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,585.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,703.20
|
| Rate for Payer: Quartz Commercial |
$8,208.00
|
| Rate for Payer: WEA Trust Commercial |
$7,524.00
|
| Rate for Payer: WPS Commercial |
$10,132.78
|
|
|
MESH VENTRALIGHT ST 20 X 25CM 5954810
|
Facility
|
IP
|
$8,081.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.69 |
| Max. Negotiated Rate |
$7,434.52 |
| Rate for Payer: Aetna Commercial |
$7,272.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,949.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.93
|
| Rate for Payer: Cash Price |
$2,424.30
|
| Rate for Payer: Cigna Commercial |
$7,434.52
|
| Rate for Payer: Health EOS Commercial |
$7,192.09
|
| Rate for Payer: HFN Commercial |
$7,434.52
|
| Rate for Payer: Multiplan Commercial |
$6,464.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,434.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.69
|
| Rate for Payer: Quartz Commercial |
$4,848.60
|
| Rate for Payer: WEA Trust Commercial |
$4,444.55
|
| Rate for Payer: WPS Commercial |
$5,985.60
|
|
|
MESH VENTRALIGHT ST 20 X 25CM 5954810
|
Facility
|
OP
|
$8,081.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.68 |
| Max. Negotiated Rate |
$32,324.00 |
| Rate for Payer: Aetna Commercial |
$7,272.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,949.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.93
|
| Rate for Payer: Cash Price |
$2,424.30
|
| Rate for Payer: Cigna Commercial |
$7,434.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,522.13
|
| Rate for Payer: Health EOS Commercial |
$7,192.09
|
| Rate for Payer: HFN Commercial |
$7,434.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.75
|
| Rate for Payer: Multiplan Commercial |
$6,464.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,434.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.69
|
| Rate for Payer: Quartz Commercial |
$5,252.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.60
|
| Rate for Payer: The Alliance Commercial |
$32,324.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.55
|
| Rate for Payer: WPS Commercial |
$5,985.60
|
|
|
MESH VENTRALIGHT ST 25 X 30CM 5954113
|
Facility
|
OP
|
$10,276.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.28 |
| Max. Negotiated Rate |
$41,104.00 |
| Rate for Payer: Aetna Commercial |
$9,248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,877.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,679.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,932.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.28
|
| Rate for Payer: Cash Price |
$3,082.80
|
| Rate for Payer: Cigna Commercial |
$9,453.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,750.45
|
| Rate for Payer: Health EOS Commercial |
$9,145.64
|
| Rate for Payer: HFN Commercial |
$9,453.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,707.00
|
| Rate for Payer: Multiplan Commercial |
$8,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,453.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.24
|
| Rate for Payer: Quartz Commercial |
$6,679.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,165.60
|
| Rate for Payer: The Alliance Commercial |
$41,104.00
|
| Rate for Payer: WEA Trust Commercial |
$5,651.80
|
| Rate for Payer: WPS Commercial |
$7,611.43
|
|
|
MESH VENTRALIGHT ST 25 X 30CM 5954113
|
Facility
|
IP
|
$10,276.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,035.24 |
| Max. Negotiated Rate |
$9,453.92 |
| Rate for Payer: Aetna Commercial |
$9,248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.28
|
| Rate for Payer: Cash Price |
$3,082.80
|
| Rate for Payer: Cigna Commercial |
$9,453.92
|
| Rate for Payer: Health EOS Commercial |
$9,145.64
|
| Rate for Payer: HFN Commercial |
$9,453.92
|
| Rate for Payer: Multiplan Commercial |
$8,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,453.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.24
|
| Rate for Payer: Quartz Commercial |
$6,165.60
|
| Rate for Payer: WEA Trust Commercial |
$5,651.80
|
| Rate for Payer: WPS Commercial |
$7,611.43
|
|
|
MESH VENTRALIGHT ST 4 X 6" (10 X 15CM) 5954460"
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,659.06
|
|
|
MESH VENTRALIGHT ST 4 X 6" (10 X 15CM) 5954460"
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.20 |
| Max. Negotiated Rate |
$19,760.00 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,383.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,211.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,371.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,764.42
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,705.00
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$3,211.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,964.00
|
| Rate for Payer: The Alliance Commercial |
$19,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,659.06
|
|
|
MESH VENTRALIGHT ST 6 x 8" (15 X 20CM) 5954680"
|
Facility
|
OP
|
$8,502.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.56 |
| Max. Negotiated Rate |
$34,008.00 |
| Rate for Payer: Aetna Commercial |
$7,651.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,311.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,380.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,526.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,080.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,506.06
|
| Rate for Payer: Cash Price |
$2,550.60
|
| Rate for Payer: Cigna Commercial |
$7,821.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.72
|
| Rate for Payer: Health EOS Commercial |
$7,566.78
|
| Rate for Payer: HFN Commercial |
$7,821.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,376.50
|
| Rate for Payer: Multiplan Commercial |
$6,801.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,821.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,165.98
|
| Rate for Payer: Quartz Commercial |
$5,526.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,101.20
|
| Rate for Payer: The Alliance Commercial |
$34,008.00
|
| Rate for Payer: WEA Trust Commercial |
$4,676.10
|
| Rate for Payer: WPS Commercial |
$6,297.43
|
|
|
MESH VENTRALIGHT ST 6 x 8" (15 X 20CM) 5954680"
|
Facility
|
IP
|
$8,502.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,165.98 |
| Max. Negotiated Rate |
$7,821.84 |
| Rate for Payer: Aetna Commercial |
$7,651.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,311.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,506.06
|
| Rate for Payer: Cash Price |
$2,550.60
|
| Rate for Payer: Cigna Commercial |
$7,821.84
|
| Rate for Payer: Health EOS Commercial |
$7,566.78
|
| Rate for Payer: HFN Commercial |
$7,821.84
|
| Rate for Payer: Multiplan Commercial |
$6,801.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,821.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,165.98
|
| Rate for Payer: Quartz Commercial |
$5,101.20
|
| Rate for Payer: WEA Trust Commercial |
$4,676.10
|
| Rate for Payer: WPS Commercial |
$6,297.43
|
|
|
MESH VICRYL 12 X 12" VKML"
|
Facility
|
OP
|
$4,952.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4038098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.56 |
| Max. Negotiated Rate |
$19,808.00 |
| Rate for Payer: Aetna Commercial |
$4,456.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,258.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,386.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,218.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,476.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,376.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.56
|
| Rate for Payer: Cash Price |
$1,485.60
|
| Rate for Payer: Cigna Commercial |
$4,555.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,771.14
|
| Rate for Payer: Health EOS Commercial |
$4,407.28
|
| Rate for Payer: HFN Commercial |
$4,555.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,714.00
|
| Rate for Payer: Multiplan Commercial |
$3,961.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,971.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,555.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.48
|
| Rate for Payer: Quartz Commercial |
$3,218.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,971.20
|
| Rate for Payer: The Alliance Commercial |
$19,808.00
|
| Rate for Payer: WEA Trust Commercial |
$2,723.60
|
| Rate for Payer: WPS Commercial |
$3,667.95
|
|
|
MESH VICRYL 12 X 12" VKML"
|
Facility
|
IP
|
$4,952.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4038098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,426.48 |
| Max. Negotiated Rate |
$4,555.84 |
| Rate for Payer: Aetna Commercial |
$4,456.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,258.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.56
|
| Rate for Payer: Cash Price |
$1,485.60
|
| Rate for Payer: Cigna Commercial |
$4,555.84
|
| Rate for Payer: Health EOS Commercial |
$4,407.28
|
| Rate for Payer: HFN Commercial |
$4,555.84
|
| Rate for Payer: Multiplan Commercial |
$3,961.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,971.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,555.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.48
|
| Rate for Payer: Quartz Commercial |
$2,971.20
|
| Rate for Payer: WEA Trust Commercial |
$2,723.60
|
| Rate for Payer: WPS Commercial |
$3,667.95
|
|
|
Mesnex 200 mg Charge
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
2958981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$15.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$4.40
|
|
|
Mesnex 200 mg Charge
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
2958981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.76
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: HFN Commercial |
$54.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$54.15
|
| Rate for Payer: Quartz Beloit One Network |
$25.08
|
| Rate for Payer: Quartz Commercial |
$32.49
|
| Rate for Payer: The Alliance Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicaid |
$1.37
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$4.40
|
|
|
Mesnex 200 mg Charge
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
2958981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Metal Clip Placement Breast Biopsy MA
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
3792844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
Metal Clip Placement Breast Biopsy MA
|
Professional
|
Both
|
$602.00
|
|
| Hospital Charge Code |
3792844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.20
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: HFN Commercial |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: The Alliance Commercial |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
Metal Clip Placement Breast Biopsy MA
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
3792844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$2,408.00 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
Metal Clip Placement Breast Biopsy US
|
Professional
|
Both
|
$602.00
|
|
| Hospital Charge Code |
3792846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.20
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: HFN Commercial |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: The Alliance Commercial |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
Metal Clip Placement Breast Biopsy US
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
3792846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
Metal Clip Placement Breast Biopsy US
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
3792846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$2,408.00 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
Metalic Biopsy Marker
|
Facility
|
IP
|
$442.00
|
|
| Hospital Charge Code |
1158868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Metalic Biopsy Marker
|
Facility
|
OP
|
$442.00
|
|
| Hospital Charge Code |
1158868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$1,768.00 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$123.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.34
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.50
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$265.20
|
| Rate for Payer: The Alliance Commercial |
$1,768.00
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
