|
Pos Combo Panel Type 44
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
| Rate for Payer: Health EOS Commercial |
$170.17
|
| Rate for Payer: HFN Commercial |
$177.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$177.65
|
| Rate for Payer: Quartz Beloit One Network |
$82.28
|
| Rate for Payer: Quartz Commercial |
$106.59
|
| Rate for Payer: The Alliance Commercial |
$93.50
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Pos Combo Panel Type 44
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.36
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.65
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Dean Health Medicaid |
$8.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.65
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.65
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.98
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.94
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.65
|
| Rate for Payer: The Alliance Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: WMAP Medicaid |
$8.94
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Positional Nystagmus Test
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
1188822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.80
|
| Rate for Payer: Health EOS Commercial |
$52.78
|
| Rate for Payer: HFN Commercial |
$55.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.90
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55.10
|
| Rate for Payer: Quartz Beloit One Network |
$25.52
|
| Rate for Payer: Quartz Commercial |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$29.00
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
POSITIONAL NYSTAGMUS TEST 92542
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 92542
|
| Hospital Charge Code |
3015333
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$101.63 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.63
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: United Healthcare Medicaid |
$30.23
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
POSITIONER HEART STARFISH EVO HP3000
|
Facility
|
IP
|
$6,404.00
|
|
| Hospital Charge Code |
4017904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,137.96 |
| Max. Negotiated Rate |
$5,891.68 |
| Rate for Payer: Aetna Commercial |
$5,763.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.12
|
| Rate for Payer: Cash Price |
$1,921.20
|
| Rate for Payer: Cigna Commercial |
$5,891.68
|
| Rate for Payer: Health EOS Commercial |
$5,699.56
|
| Rate for Payer: HFN Commercial |
$5,891.68
|
| Rate for Payer: Multiplan Commercial |
$5,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,891.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,137.96
|
| Rate for Payer: Quartz Commercial |
$3,842.40
|
| Rate for Payer: WEA Trust Commercial |
$3,522.20
|
| Rate for Payer: WPS Commercial |
$4,743.44
|
|
|
POSITIONER HEART STARFISH EVO HP3000
|
Facility
|
OP
|
$6,404.00
|
|
| Hospital Charge Code |
4017904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,793.12 |
| Max. Negotiated Rate |
$25,616.00 |
| Rate for Payer: Aetna Commercial |
$5,763.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,162.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,073.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.12
|
| Rate for Payer: Cash Price |
$1,921.20
|
| Rate for Payer: Cigna Commercial |
$5,891.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,583.68
|
| Rate for Payer: Health EOS Commercial |
$5,699.56
|
| Rate for Payer: HFN Commercial |
$5,891.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,803.00
|
| Rate for Payer: Multiplan Commercial |
$5,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,891.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,137.96
|
| Rate for Payer: Quartz Commercial |
$4,162.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,842.40
|
| Rate for Payer: The Alliance Commercial |
$25,616.00
|
| Rate for Payer: WEA Trust Commercial |
$3,522.20
|
| Rate for Payer: WPS Commercial |
$4,743.44
|
|
|
POSITIONER PINK PAD XL 40595
|
Facility
|
IP
|
$1,683.00
|
|
| Hospital Charge Code |
5415184
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$824.67 |
| Max. Negotiated Rate |
$1,548.36 |
| Rate for Payer: Aetna Commercial |
$1,514.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,447.38
|
| 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: Health EOS Commercial |
$1,497.87
|
| Rate for Payer: HFN Commercial |
$1,548.36
|
| 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 |
$1,009.80
|
| Rate for Payer: WEA Trust Commercial |
$925.65
|
| Rate for Payer: WPS Commercial |
$1,246.60
|
|
|
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
|
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 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 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
|
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 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 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
|
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 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 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
|
|
|
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
|
|
|
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 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 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
|
|
