|
PACKING NASAL 5.5cm ANTERIOR #551
|
Facility
|
OP
|
$719.00
|
|
| Hospital Charge Code |
2969617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.32 |
| Max. Negotiated Rate |
$2,876.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Aetna Managed Medicare |
$201.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.35
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.25
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$467.35
|
| Rate for Payer: Quartz Medicare Advantage |
$431.40
|
| Rate for Payer: The Alliance Commercial |
$2,876.00
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
PACKING NASAL 5.5 UNILATERAL RR550
|
Facility
|
IP
|
$642.00
|
|
| Hospital Charge Code |
2973425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.26
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$590.64
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$590.64
|
| Rate for Payer: Quartz Beloit One Network |
$314.58
|
| Rate for Payer: Quartz Commercial |
$385.20
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
PACKING NASAL 5.5 UNILATERAL RR550
|
Facility
|
OP
|
$642.00
|
|
| Hospital Charge Code |
2973425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.76 |
| Max. Negotiated Rate |
$2,568.00 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Aetna Managed Medicare |
$179.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.26
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$590.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.26
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$481.50
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$590.64
|
| Rate for Payer: Quartz Beloit One Network |
$314.58
|
| Rate for Payer: Quartz Commercial |
$417.30
|
| Rate for Payer: Quartz Medicare Advantage |
$385.20
|
| Rate for Payer: The Alliance Commercial |
$2,568.00
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
PACKING NASAL RAPID RHINO RR 751
|
Facility
|
IP
|
$719.00
|
|
| Hospital Charge Code |
2964722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.31 |
| Max. Negotiated Rate |
$661.48 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$431.40
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
PACKING NASAL RAPID RHINO RR 751
|
Facility
|
OP
|
$719.00
|
|
| Hospital Charge Code |
2964722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.32 |
| Max. Negotiated Rate |
$2,876.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Aetna Managed Medicare |
$201.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.35
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.25
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$467.35
|
| Rate for Payer: Quartz Medicare Advantage |
$431.40
|
| Rate for Payer: The Alliance Commercial |
$2,876.00
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
PACKING PLAIN 1
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
2968999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
PACKING PLAIN 1
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
2968999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
PACKING PLAIN 1/2 X 5
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2964057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
PACKING PLAIN 1/2 X 5
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2964057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
PACKING PLAIN 1/4
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2969446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.60
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
PACKING PLAIN 1/4
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2969446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
PACKING STRIPS 1/2 CURITY AMD
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2969225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
PACKING STRIPS 1/2 CURITY AMD
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2969225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
PACKING STRIPS 1/4 X 1YRD AMD
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
2963595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
PACKING STRIPS 1/4 X 1YRD AMD
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
2963595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$63.00
|
| Rate for Payer: The Alliance Commercial |
$420.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Packing strips charge
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
2844922
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$77.40
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Packing strips charge
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
2844922
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Aetna Managed Medicare |
$36.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.19
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$83.85
|
| Rate for Payer: Quartz Medicare Advantage |
$77.40
|
| Rate for Payer: The Alliance Commercial |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
PACK LAPAROSCOPY w/GOWN 88222
|
Facility
|
OP
|
$532.00
|
|
| Hospital Charge Code |
2963186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$2,128.00 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.52
|
| Rate for Payer: Aetna Managed Medicare |
$148.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.96
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$489.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.71
|
| Rate for Payer: Health EOS Commercial |
$473.48
|
| Rate for Payer: HFN Commercial |
$489.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: NAPHCARE Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$489.44
|
| Rate for Payer: Quartz Beloit One Network |
$260.68
|
| Rate for Payer: Quartz Commercial |
$345.80
|
| Rate for Payer: Quartz Medicare Advantage |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$2,128.00
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
PACK LAPAROSCOPY w/GOWN 88222
|
Facility
|
IP
|
$532.00
|
|
| Hospital Charge Code |
2963186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.68 |
| Max. Negotiated Rate |
$489.44 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.96
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$489.44
|
| Rate for Payer: Health EOS Commercial |
$473.48
|
| Rate for Payer: HFN Commercial |
$489.44
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: NAPHCARE Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$489.44
|
| Rate for Payer: Quartz Beloit One Network |
$260.68
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
PACK LINE INSERTION BARRIER
|
Facility
|
IP
|
$431.00
|
|
| Hospital Charge Code |
2962938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
PACK LINE INSERTION BARRIER
|
Facility
|
OP
|
$431.00
|
|
| Hospital Charge Code |
2962938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,724.00 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.19
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: The Alliance Commercial |
$1,724.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
PACK LITHOTOMY PERI-GYNE IV 88541
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
2962813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Aetna Managed Medicare |
$68.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.66
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$159.90
|
| Rate for Payer: Quartz Medicare Advantage |
$147.60
|
| Rate for Payer: The Alliance Commercial |
$984.00
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
PACK LITHOTOMY PERI-GYNE IV 88541
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
2962813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$147.60
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
PACK MAJOR SET UP DNYJ30559F 2957
|
Facility
|
IP
|
$918.00
|
|
| Hospital Charge Code |
2975360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.54
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$844.56
|
| Rate for Payer: Health EOS Commercial |
$817.02
|
| Rate for Payer: HFN Commercial |
$844.56
|
| Rate for Payer: Multiplan Commercial |
$734.40
|
| Rate for Payer: NAPHCARE Commercial |
$550.80
|
| Rate for Payer: Preferred Network Access Commercial |
$844.56
|
| Rate for Payer: Quartz Beloit One Network |
$449.82
|
| Rate for Payer: Quartz Commercial |
$550.80
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
|
PACK MAJOR SET UP DNYJ30559F 2957
|
Facility
|
OP
|
$918.00
|
|
| Hospital Charge Code |
2975360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Aetna Managed Medicare |
$257.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.54
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$844.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.71
|
| Rate for Payer: Health EOS Commercial |
$817.02
|
| Rate for Payer: HFN Commercial |
$844.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$688.50
|
| Rate for Payer: Multiplan Commercial |
$734.40
|
| Rate for Payer: NAPHCARE Commercial |
$550.80
|
| Rate for Payer: Preferred Network Access Commercial |
$844.56
|
| Rate for Payer: Quartz Beloit One Network |
$449.82
|
| Rate for Payer: Quartz Commercial |
$596.70
|
| Rate for Payer: Quartz Medicare Advantage |
$550.80
|
| Rate for Payer: The Alliance Commercial |
$3,672.00
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
