|
POSITIONER PINK PAD XL 40595
|
Facility
|
OP
|
$1,683.00
|
|
| Hospital Charge Code |
5415184
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$471.24 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Aetna Commercial |
$1,514.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,447.38
|
| Rate for Payer: Aetna Managed Medicare |
$471.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,093.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$841.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$807.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$891.99
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,548.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$941.81
|
| Rate for Payer: Health EOS Commercial |
$1,497.87
|
| Rate for Payer: HFN Commercial |
$1,548.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,262.25
|
| Rate for Payer: Multiplan Commercial |
$1,346.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,009.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,548.36
|
| Rate for Payer: Quartz Beloit One Network |
$824.67
|
| Rate for Payer: Quartz Commercial |
$1,093.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,009.80
|
| Rate for Payer: The Alliance Commercial |
$6,732.00
|
| Rate for Payer: WEA Trust Commercial |
$925.65
|
| Rate for Payer: WPS Commercial |
$1,246.60
|
|
|
POSITIONER PRECISE BITE W/TONGUE DEPRESSOR MTCBPBITETD
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4594875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
POSITIONER PRECISE BITE W/TONGUE DEPRESSOR MTCBPBITETD
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4594875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.48 |
| Max. Negotiated Rate |
$4,864.00 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$340.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$729.60
|
| Rate for Payer: The Alliance Commercial |
$4,864.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
POSITIONER PRONE #P-39-01
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
2972841
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$77.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$165.60
|
| Rate for Payer: The Alliance Commercial |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
POSITIONER PRONE #P-39-01
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
2972841
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
POSITIONER RUMI 2.5 KC-RUMI-25
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 2.5 KC-RUMI-25
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 3.0 KC-RUMI-30
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 3.0 KC-RUMI-30
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 3.5 KC-RUMI-35
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 3.5 KC-RUMI-35
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 4.0 KC-RUMI-40
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER RUMI 4.0 KC-RUMI-40
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
POSITIONER Z-FLO ADULT SM 12X20 1401007
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
5729701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.64 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$276.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$552.88
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$642.20
|
| Rate for Payer: Quartz Medicare Advantage |
$592.80
|
| Rate for Payer: The Alliance Commercial |
$3,952.00
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
POSITIONER Z-FLO ADULT SM 12X20 1401007
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
5729701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.12 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
POSITIONING PIN 4.5MM CERCLAGE 298.803S
|
Facility
|
OP
|
$2,571.00
|
|
| Hospital Charge Code |
2966382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$719.88 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Aetna Commercial |
$2,313.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.06
|
| Rate for Payer: Aetna Managed Medicare |
$719.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,671.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,285.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,234.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.63
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cigna Commercial |
$2,365.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,438.73
|
| Rate for Payer: Health EOS Commercial |
$2,288.19
|
| Rate for Payer: HFN Commercial |
$2,365.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,928.25
|
| Rate for Payer: Multiplan Commercial |
$2,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,365.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.79
|
| Rate for Payer: Quartz Commercial |
$1,671.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,542.60
|
| Rate for Payer: The Alliance Commercial |
$10,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,414.05
|
| Rate for Payer: WPS Commercial |
$1,904.34
|
|
|
POSITIONING PIN 4.5MM CERCLAGE 298.803S
|
Facility
|
IP
|
$2,571.00
|
|
| Hospital Charge Code |
2966382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,259.79 |
| Max. Negotiated Rate |
$2,365.32 |
| Rate for Payer: Aetna Commercial |
$2,313.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.63
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cigna Commercial |
$2,365.32
|
| Rate for Payer: Health EOS Commercial |
$2,288.19
|
| Rate for Payer: HFN Commercial |
$2,365.32
|
| Rate for Payer: Multiplan Commercial |
$2,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,365.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.79
|
| Rate for Payer: Quartz Commercial |
$1,542.60
|
| Rate for Payer: WEA Trust Commercial |
$1,414.05
|
| Rate for Payer: WPS Commercial |
$1,904.34
|
|
|
POSITIONING PIN 5.0MM 02.231.022S
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6178022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna Commercial |
$945.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$556.50
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$966.00
|
| Rate for Payer: Health EOS Commercial |
$934.50
|
| Rate for Payer: HFN Commercial |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: NAPHCARE Commercial |
$630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$966.00
|
| Rate for Payer: Quartz Beloit One Network |
$514.50
|
| Rate for Payer: Quartz Commercial |
$630.00
|
| Rate for Payer: WEA Trust Commercial |
$577.50
|
| Rate for Payer: WPS Commercial |
$777.74
|
|
|
POSITIONING PIN 5.0MM 02.231.022S
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6178022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$945.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.00
|
| Rate for Payer: Aetna Managed Medicare |
$294.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$682.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$556.50
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$966.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$587.58
|
| Rate for Payer: Health EOS Commercial |
$934.50
|
| Rate for Payer: HFN Commercial |
$966.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: NAPHCARE Commercial |
$630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$966.00
|
| Rate for Payer: Quartz Beloit One Network |
$514.50
|
| Rate for Payer: Quartz Commercial |
$682.50
|
| Rate for Payer: Quartz Medicare Advantage |
$630.00
|
| Rate for Payer: The Alliance Commercial |
$4,200.00
|
| Rate for Payer: WEA Trust Commercial |
$577.50
|
| Rate for Payer: WPS Commercial |
$777.74
|
|
|
Positive - Rapid Strep Test
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3052340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.44
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Positive - Rapid Strep Test
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3052340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Positive - Urine Pregnancy POC
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$8.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.29
|
| Rate for Payer: Anthem Medicaid |
$8.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.61
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Dean Health Medicaid |
$8.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.61
|
| Rate for Payer: Managed Health Services Medicaid |
$9.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.92
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.90
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8.61
|
| Rate for Payer: The Alliance Commercial |
$34.44
|
| Rate for Payer: United Healthcare Medicaid |
$8.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$8.61
|
| Rate for Payer: WMAP Medicaid |
$8.90
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Positive - Urine Pregnancy POC
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
POST CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 20MM AR-9561-20P
|
Facility
|
OP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,962.24 |
| Max. Negotiated Rate |
$28,032.00 |
| Rate for Payer: Aetna Commercial |
$6,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,962.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,555.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,504.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,714.24
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,447.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,921.68
|
| Rate for Payer: Health EOS Commercial |
$6,237.12
|
| Rate for Payer: HFN Commercial |
$6,447.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,256.00
|
| Rate for Payer: Multiplan Commercial |
$5,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,447.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.92
|
| Rate for Payer: Quartz Commercial |
$4,555.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,204.80
|
| Rate for Payer: The Alliance Commercial |
$28,032.00
|
| Rate for Payer: WEA Trust Commercial |
$3,854.40
|
| Rate for Payer: WPS Commercial |
$5,190.83
|
|
|
POST CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 20MM AR-9561-20P
|
Facility
|
IP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.92 |
| Max. Negotiated Rate |
$6,447.36 |
| Rate for Payer: Aetna Commercial |
$6,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,714.24
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,447.36
|
| Rate for Payer: Health EOS Commercial |
$6,237.12
|
| Rate for Payer: HFN Commercial |
$6,447.36
|
| Rate for Payer: Multiplan Commercial |
$5,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,447.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.92
|
| Rate for Payer: Quartz Commercial |
$4,204.80
|
| Rate for Payer: WEA Trust Commercial |
$3,854.40
|
| Rate for Payer: WPS Commercial |
$5,190.83
|
|
