|
Posaconazole, LC/MS/MS
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5094644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$204.05
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
Pos Combo Panel Type 34
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Pos Combo Panel Type 34
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Pos Combo Panel Type 34
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
Pos Combo Panel Type 44
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Pos Combo Panel Type 44
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Pos Combo Panel Type 44
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
Positional Nystagmus Test
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
1188822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.19
|
| Rate for Payer: Health EOS Commercial |
$54.89
|
| Rate for Payer: HFN Commercial |
$57.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.30
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: Preferred Network Access Commercial |
$57.30
|
| Rate for Payer: Quartz Beloit One Network |
$26.54
|
| Rate for Payer: Quartz Commercial |
$34.38
|
| Rate for Payer: The Alliance Commercial |
$30.16
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
POSITIONAL NYSTAGMUS TEST 92542
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 92542
|
| Hospital Charge Code |
3015333
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$114.07 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$28.52
|
| Rate for Payer: Anthem Medicare Advantage |
$28.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.52
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$42.78
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.52
|
| Rate for Payer: The Alliance Commercial |
$71.29
|
| Rate for Payer: United Healthcare Medicaid |
$31.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.52
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
POSITIONER HEART STARFISH EVO HP3000
|
Facility
|
OP
|
$6,404.00
|
|
| Hospital Charge Code |
4017904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,864.84 |
| Max. Negotiated Rate |
$6,127.35 |
| Rate for Payer: Aetna Commercial |
$5,994.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,727.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,864.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,329.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,330.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,196.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,529.88
|
| Rate for Payer: Cash Price |
$1,921.20
|
| Rate for Payer: Cigna Commercial |
$6,127.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,727.13
|
| Rate for Payer: Health EOS Commercial |
$5,927.54
|
| Rate for Payer: HFN Commercial |
$6,127.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,995.12
|
| Rate for Payer: Multiplan Commercial |
$5,328.13
|
| Rate for Payer: NAPHCARE Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$6,127.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,263.48
|
| Rate for Payer: Quartz Commercial |
$4,329.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,996.10
|
| Rate for Payer: The Alliance Commercial |
$3,330.08
|
| Rate for Payer: WEA Trust Commercial |
$3,663.09
|
| Rate for Payer: WPS Commercial |
$4,933.00
|
|
|
POSITIONER HEART STARFISH EVO HP3000
|
Facility
|
IP
|
$6,404.00
|
|
| Hospital Charge Code |
4017904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,263.48 |
| Max. Negotiated Rate |
$6,127.35 |
| Rate for Payer: Aetna Commercial |
$5,994.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,727.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,529.88
|
| Rate for Payer: Cash Price |
$1,921.20
|
| Rate for Payer: Cigna Commercial |
$6,127.35
|
| Rate for Payer: Health EOS Commercial |
$5,927.54
|
| Rate for Payer: HFN Commercial |
$6,127.35
|
| Rate for Payer: Multiplan Commercial |
$5,328.13
|
| Rate for Payer: Preferred Network Access Commercial |
$6,127.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,263.48
|
| Rate for Payer: Quartz Commercial |
$3,996.10
|
| Rate for Payer: WEA Trust Commercial |
$3,663.09
|
| Rate for Payer: WPS Commercial |
$4,933.00
|
|
|
POSITIONER PINK PAD XL 40595
|
Facility
|
IP
|
$1,683.00
|
|
| Hospital Charge Code |
5415184
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$857.66 |
| Max. Negotiated Rate |
$1,610.29 |
| Rate for Payer: Aetna Commercial |
$1,575.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.67
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,610.29
|
| Rate for Payer: Health EOS Commercial |
$1,557.78
|
| Rate for Payer: HFN Commercial |
$1,610.29
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.29
|
| Rate for Payer: Quartz Beloit One Network |
$857.66
|
| Rate for Payer: Quartz Commercial |
$1,050.19
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: WPS Commercial |
$1,296.41
|
|
|
POSITIONER PINK PAD XL 40595
|
Facility
|
OP
|
$1,683.00
|
|
| Hospital Charge Code |
5415184
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$490.09 |
| Max. Negotiated Rate |
$1,610.29 |
| Rate for Payer: Aetna Commercial |
$1,575.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Aetna Managed Medicare |
$490.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.67
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,610.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.51
|
| Rate for Payer: Health EOS Commercial |
$1,557.78
|
| Rate for Payer: HFN Commercial |
$1,610.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,312.74
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.29
|
| Rate for Payer: Quartz Beloit One Network |
$857.66
|
| Rate for Payer: Quartz Commercial |
$1,137.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.19
|
| Rate for Payer: The Alliance Commercial |
$875.16
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: WPS Commercial |
$1,296.41
|
|
|
POSITIONER PRECISE BITE W/TONGUE DEPRESSOR MTCBPBITETD
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4594875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
POSITIONER PRECISE BITE W/TONGUE DEPRESSOR MTCBPBITETD
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4594875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$354.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.71
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.48
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$758.78
|
| Rate for Payer: The Alliance Commercial |
$632.32
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
POSITIONER PRONE #P-39-01
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
2972841
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$80.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$172.22
|
| Rate for Payer: The Alliance Commercial |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
POSITIONER PRONE #P-39-01
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
2972841
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
POSITIONER RUMI 2.5 KC-RUMI-25
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 2.5 KC-RUMI-25
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 3.0 KC-RUMI-30
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 3.0 KC-RUMI-30
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 3.5 KC-RUMI-35
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 3.5 KC-RUMI-35
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 4.0 KC-RUMI-40
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
POSITIONER RUMI 4.0 KC-RUMI-40
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
