|
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
|
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 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 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 3.0 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 3.5 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 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 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
|
|
|
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 Z-FLO ADULT SM 12X20 1401007
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
5729701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$287.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.02
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$616.51
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$616.51
|
| Rate for Payer: The Alliance Commercial |
$513.76
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
POSITIONER Z-FLO ADULT SM 12X20 1401007
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
5729701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
POSITIONING PIN 4.5MM CERCLAGE 298.803S
|
Facility
|
IP
|
$2,571.00
|
|
| Hospital Charge Code |
2966382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.18 |
| Max. Negotiated Rate |
$2,459.93 |
| Rate for Payer: Aetna Commercial |
$2,406.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.14
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cigna Commercial |
$2,459.93
|
| Rate for Payer: Health EOS Commercial |
$2,379.72
|
| Rate for Payer: HFN Commercial |
$2,459.93
|
| Rate for Payer: Multiplan Commercial |
$2,139.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,459.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.18
|
| Rate for Payer: Quartz Commercial |
$1,604.30
|
| Rate for Payer: WEA Trust Commercial |
$1,470.61
|
| Rate for Payer: WPS Commercial |
$1,980.44
|
|
|
POSITIONING PIN 4.5MM CERCLAGE 298.803S
|
Facility
|
OP
|
$2,571.00
|
|
| Hospital Charge Code |
2966382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.68 |
| Max. Negotiated Rate |
$2,459.93 |
| Rate for Payer: Aetna Commercial |
$2,406.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.50
|
| Rate for Payer: Aetna Managed Medicare |
$748.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,336.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.14
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cigna Commercial |
$2,459.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.32
|
| Rate for Payer: Health EOS Commercial |
$2,379.72
|
| Rate for Payer: HFN Commercial |
$2,459.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.38
|
| Rate for Payer: Multiplan Commercial |
$2,139.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,459.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.18
|
| Rate for Payer: Quartz Commercial |
$1,738.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.30
|
| Rate for Payer: The Alliance Commercial |
$1,336.92
|
| Rate for Payer: WEA Trust Commercial |
$1,470.61
|
| Rate for Payer: WPS Commercial |
$1,980.44
|
|
|
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 |
$305.76 |
| Max. Negotiated Rate |
$1,004.64 |
| Rate for Payer: Aetna Commercial |
$982.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.12
|
| Rate for Payer: Aetna Managed Medicare |
$305.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$709.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$578.76
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$1,004.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.10
|
| Rate for Payer: Health EOS Commercial |
$971.88
|
| Rate for Payer: HFN Commercial |
$1,004.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$873.60
|
| Rate for Payer: NAPHCARE Commercial |
$655.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.64
|
| Rate for Payer: Quartz Beloit One Network |
$535.08
|
| Rate for Payer: Quartz Commercial |
$709.80
|
| Rate for Payer: Quartz Medicare Advantage |
$655.20
|
| Rate for Payer: The Alliance Commercial |
$546.00
|
| Rate for Payer: WEA Trust Commercial |
$600.60
|
| Rate for Payer: WPS Commercial |
$808.82
|
|
|
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 |
$535.08 |
| Max. Negotiated Rate |
$1,004.64 |
| Rate for Payer: Aetna Commercial |
$982.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$578.76
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$1,004.64
|
| Rate for Payer: Health EOS Commercial |
$971.88
|
| Rate for Payer: HFN Commercial |
$1,004.64
|
| Rate for Payer: Multiplan Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.64
|
| Rate for Payer: Quartz Beloit One Network |
$535.08
|
| Rate for Payer: Quartz Commercial |
$655.20
|
| Rate for Payer: WEA Trust Commercial |
$600.60
|
| Rate for Payer: WPS Commercial |
$808.82
|
|
|
Positive - Rapid Strep Test
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3052340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$124.18
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
Positive - Rapid Strep Test
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3052340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$17.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.54
|
| Rate for Payer: Anthem Medicare Advantage |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.19
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.19
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| Rate for Payer: Quartz Medicare Advantage |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$68.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.19
|
| Rate for Payer: United Healthcare PPO |
$155.22
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: Wellcare Medicare |
$17.19
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
