|
MEPILEX 4X6 BORDER AG DRESSING 498300"
|
Facility
|
IP
|
$709.00
|
|
| Hospital Charge Code |
2963646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$442.42
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
Mercury Level
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$282.57 |
| Rate for Payer: Aetna Commercial |
$282.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$282.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$270.67
|
| Rate for Payer: HFN Commercial |
$282.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$282.57
|
| Rate for Payer: Quartz Beloit One Network |
$130.87
|
| Rate for Payer: Quartz Commercial |
$169.54
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$66.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
Mercury Level
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Mercury Level
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$193.34
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$67.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare PPO |
$223.08
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Mercury Level
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
978013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$251.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$257.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$248.99
|
| Rate for Payer: HFN Commercial |
$257.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$257.38
|
| Rate for Payer: Quartz Beloit One Network |
$137.08
|
| Rate for Payer: Quartz Commercial |
$181.84
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$67.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare PPO |
$209.82
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
| Rate for Payer: WPS Commercial |
$207.21
|
|
|
Mercury Level
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
978013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$66.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
Mercury Level
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
978013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.08 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$251.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.27
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$257.38
|
| Rate for Payer: Health EOS Commercial |
$248.99
|
| Rate for Payer: HFN Commercial |
$257.38
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: Preferred Network Access Commercial |
$257.38
|
| Rate for Payer: Quartz Beloit One Network |
$137.08
|
| Rate for Payer: Quartz Commercial |
$167.86
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$207.21
|
|
|
Mercury, Urine
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
5364646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$67.64 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$67.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Mercury, Urine
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
5364646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Mercury, Urine
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
5364646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$74.41 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$66.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
MEROCEL AMBRUS EAR PACKING 400354
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
3259481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
MEROCEL AMBRUS EAR PACKING 400354
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
3259481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
MESH 12 X 12 PROCEED RECTANGLE PCDL1
|
Facility
|
IP
|
$11,413.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,816.06 |
| Max. Negotiated Rate |
$10,919.96 |
| Rate for Payer: Aetna Commercial |
$10,682.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,207.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,290.85
|
| Rate for Payer: Cash Price |
$3,423.90
|
| Rate for Payer: Cigna Commercial |
$10,919.96
|
| Rate for Payer: Health EOS Commercial |
$10,563.87
|
| Rate for Payer: HFN Commercial |
$10,919.96
|
| Rate for Payer: Multiplan Commercial |
$9,495.62
|
| Rate for Payer: Preferred Network Access Commercial |
$10,919.96
|
| Rate for Payer: Quartz Beloit One Network |
$5,816.06
|
| Rate for Payer: Quartz Commercial |
$7,121.71
|
| Rate for Payer: WEA Trust Commercial |
$6,528.24
|
| Rate for Payer: WPS Commercial |
$8,791.43
|
|
|
MESH 12 X 12 PROCEED RECTANGLE PCDL1
|
Facility
|
OP
|
$11,413.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.47 |
| Max. Negotiated Rate |
$10,919.96 |
| Rate for Payer: Aetna Commercial |
$10,682.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,207.79
|
| Rate for Payer: Aetna Managed Medicare |
$3,323.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,715.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,934.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,697.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,290.85
|
| Rate for Payer: Cash Price |
$3,423.90
|
| Rate for Payer: Cigna Commercial |
$10,919.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,642.37
|
| Rate for Payer: Health EOS Commercial |
$10,563.87
|
| Rate for Payer: HFN Commercial |
$10,919.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,902.14
|
| Rate for Payer: Multiplan Commercial |
$9,495.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,121.71
|
| Rate for Payer: Preferred Network Access Commercial |
$10,919.96
|
| Rate for Payer: Quartz Beloit One Network |
$5,816.06
|
| Rate for Payer: Quartz Commercial |
$7,715.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7,121.71
|
| Rate for Payer: The Alliance Commercial |
$5,934.76
|
| Rate for Payer: WEA Trust Commercial |
$6,528.24
|
| Rate for Payer: WPS Commercial |
$8,791.43
|
|
|
MESH 3D MAX LIGHT RT LARGE 0117321
|
Facility
|
IP
|
$2,918.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,487.01 |
| Max. Negotiated Rate |
$2,791.94 |
| Rate for Payer: Aetna Commercial |
$2,731.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,609.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,608.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,791.94
|
| Rate for Payer: Health EOS Commercial |
$2,700.90
|
| Rate for Payer: HFN Commercial |
$2,791.94
|
| Rate for Payer: Multiplan Commercial |
$2,427.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,791.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,487.01
|
| Rate for Payer: Quartz Commercial |
$1,820.83
|
| Rate for Payer: WEA Trust Commercial |
$1,669.10
|
| Rate for Payer: WPS Commercial |
$2,247.74
|
|
|
MESH 3D MAX LIGHT RT LARGE 0117321
|
Facility
|
OP
|
$2,918.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$849.72 |
| Max. Negotiated Rate |
$2,791.94 |
| Rate for Payer: Aetna Commercial |
$2,731.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,609.86
|
| Rate for Payer: Aetna Managed Medicare |
$849.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,972.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,517.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,456.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,608.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,791.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,698.28
|
| Rate for Payer: Health EOS Commercial |
$2,700.90
|
| Rate for Payer: HFN Commercial |
$2,791.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,276.04
|
| Rate for Payer: Multiplan Commercial |
$2,427.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,820.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,791.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,487.01
|
| Rate for Payer: Quartz Commercial |
$1,972.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,820.83
|
| Rate for Payer: The Alliance Commercial |
$1,517.36
|
| Rate for Payer: WEA Trust Commercial |
$1,669.10
|
| Rate for Payer: WPS Commercial |
$2,247.74
|
|
|
MESH 3D MAX LT EX-LARGE 0115322
|
Facility
|
OP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.38 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Aetna Managed Medicare |
$748.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,737.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,282.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,495.74
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,004.60
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,603.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,737.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,603.68
|
| Rate for Payer: The Alliance Commercial |
$1,336.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
MESH 3D MAX LT EX-LARGE 0115322
|
Facility
|
IP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,603.68
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
MESH 3D MAX LT LARGE 0115311
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,599.63 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$1,958.74
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
MESH 3D MAX LT LARGE 0115311
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
MESH 3D MAX LT MED 0115310
|
Facility
|
IP
|
$2,869.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.04 |
| Max. Negotiated Rate |
$2,745.06 |
| Rate for Payer: Aetna Commercial |
$2,685.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.39
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,745.06
|
| Rate for Payer: Health EOS Commercial |
$2,655.55
|
| Rate for Payer: HFN Commercial |
$2,745.06
|
| Rate for Payer: Multiplan Commercial |
$2,387.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.04
|
| Rate for Payer: Quartz Commercial |
$1,790.26
|
| Rate for Payer: WEA Trust Commercial |
$1,641.07
|
| Rate for Payer: WPS Commercial |
$2,209.99
|
|
|
MESH 3D MAX LT MED 0115310
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$835.45 |
| Max. Negotiated Rate |
$2,745.06 |
| Rate for Payer: Aetna Commercial |
$2,685.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.03
|
| Rate for Payer: Aetna Managed Medicare |
$835.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,939.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,432.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.39
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,745.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.76
|
| Rate for Payer: Health EOS Commercial |
$2,655.55
|
| Rate for Payer: HFN Commercial |
$2,745.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,237.82
|
| Rate for Payer: Multiplan Commercial |
$2,387.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,790.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.04
|
| Rate for Payer: Quartz Commercial |
$1,939.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,790.26
|
| Rate for Payer: The Alliance Commercial |
$1,491.88
|
| Rate for Payer: WEA Trust Commercial |
$1,641.07
|
| Rate for Payer: WPS Commercial |
$2,209.99
|
|
|
MESH 3D MAX RT EX-LARGE 0115312
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.01 |
| Max. Negotiated Rate |
$2,369.04 |
| Rate for Payer: Aetna Commercial |
$2,317.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,214.53
|
| Rate for Payer: Aetna Managed Medicare |
$721.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,673.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,287.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.77
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,369.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,441.03
|
| Rate for Payer: Health EOS Commercial |
$2,291.79
|
| Rate for Payer: HFN Commercial |
$2,369.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,931.28
|
| Rate for Payer: Multiplan Commercial |
$2,060.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,545.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.77
|
| Rate for Payer: Quartz Commercial |
$1,673.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,545.02
|
| Rate for Payer: The Alliance Commercial |
$1,287.52
|
| Rate for Payer: WEA Trust Commercial |
$1,416.27
|
| Rate for Payer: WPS Commercial |
$1,907.26
|
|
|
MESH 3D MAX RT EX-LARGE 0115312
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.77 |
| Max. Negotiated Rate |
$2,369.04 |
| Rate for Payer: Aetna Commercial |
$2,317.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,214.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.77
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,369.04
|
| Rate for Payer: Health EOS Commercial |
$2,291.79
|
| Rate for Payer: HFN Commercial |
$2,369.04
|
| Rate for Payer: Multiplan Commercial |
$2,060.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.77
|
| Rate for Payer: Quartz Commercial |
$1,545.02
|
| Rate for Payer: WEA Trust Commercial |
$1,416.27
|
| Rate for Payer: WPS Commercial |
$1,907.26
|
|
|
MESH 3D MAX RT LARGE 0115321
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
