|
SINUS BALLOON SEEKER EM SPHENOID 6 X 17MM MEDTRONIC 1830617SPH
|
Facility
|
OP
|
$3,888.00
|
|
| Hospital Charge Code |
4230454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.64 |
| Max. Negotiated Rate |
$15,552.00 |
| Rate for Payer: Aetna Commercial |
$3,499.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,088.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,527.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,944.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,866.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,576.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,175.72
|
| Rate for Payer: Health EOS Commercial |
$3,460.32
|
| Rate for Payer: HFN Commercial |
$3,576.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,916.00
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,576.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.12
|
| Rate for Payer: Quartz Commercial |
$2,527.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,332.80
|
| Rate for Payer: The Alliance Commercial |
$15,552.00
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
SINUS BALLOON SEEKER EM SPHENOID 6 X 17MM MEDTRONIC 1830617SPH
|
Facility
|
IP
|
$3,888.00
|
|
| Hospital Charge Code |
4230454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$3,576.96 |
| Rate for Payer: Aetna Commercial |
$3,499.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,576.96
|
| Rate for Payer: Health EOS Commercial |
$3,460.32
|
| Rate for Payer: HFN Commercial |
$3,576.96
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,576.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.12
|
| Rate for Payer: Quartz Commercial |
$2,332.80
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
SINUS BALLOON SYSTEM RELIEVA SPINPLUS SINUPLASTY BALLOON 6 X 16MM ACCLARENT RSP0616MFS
|
Facility
|
IP
|
$11,435.00
|
|
| Hospital Charge Code |
5178632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,603.15 |
| Max. Negotiated Rate |
$10,520.20 |
| Rate for Payer: Aetna Commercial |
$10,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,834.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,060.55
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cigna Commercial |
$10,520.20
|
| Rate for Payer: Health EOS Commercial |
$10,177.15
|
| Rate for Payer: HFN Commercial |
$10,520.20
|
| Rate for Payer: Multiplan Commercial |
$9,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,520.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,603.15
|
| Rate for Payer: Quartz Commercial |
$6,861.00
|
| Rate for Payer: WEA Trust Commercial |
$6,289.25
|
| Rate for Payer: WPS Commercial |
$8,469.90
|
|
|
SINUS BALLOON SYSTEM RELIEVA SPINPLUS SINUPLASTY BALLOON 6 X 16MM ACCLARENT RSP0616MFS
|
Facility
|
OP
|
$11,435.00
|
|
| Hospital Charge Code |
5178632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,201.80 |
| Max. Negotiated Rate |
$45,740.00 |
| Rate for Payer: Aetna Commercial |
$10,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,834.10
|
| Rate for Payer: Aetna Managed Medicare |
$3,201.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,432.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,717.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,488.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,060.55
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cigna Commercial |
$10,520.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,399.03
|
| Rate for Payer: Health EOS Commercial |
$10,177.15
|
| Rate for Payer: HFN Commercial |
$10,520.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,576.25
|
| Rate for Payer: Multiplan Commercial |
$9,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,520.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,603.15
|
| Rate for Payer: Quartz Commercial |
$7,432.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,861.00
|
| Rate for Payer: The Alliance Commercial |
$45,740.00
|
| Rate for Payer: WEA Trust Commercial |
$6,289.25
|
| Rate for Payer: WPS Commercial |
$8,469.90
|
|
|
SINUS PACK BARON REG 400407
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2965313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SINUS PACK BARON REG 400407
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2965313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SINUS PACK BARON SLIM 400427
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2965314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SINUS PACK BARON SLIM 400427
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2965314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Size 6 - Percutaneous Tracheostomy Kit
|
Facility
|
OP
|
$3,659.00
|
|
| Hospital Charge Code |
5707630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,024.52 |
| Max. Negotiated Rate |
$14,636.00 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,024.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,378.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,829.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,756.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.27
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,047.58
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,744.25
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,195.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,378.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,195.40
|
| Rate for Payer: The Alliance Commercial |
$14,636.00
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
Size 6 - Percutaneous Tracheostomy Kit
|
Facility
|
IP
|
$3,659.00
|
|
| Hospital Charge Code |
5707630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,792.91 |
| Max. Negotiated Rate |
$3,366.28 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.27
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,195.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,195.40
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
Size 8 - Percutaneous Tracheostomy Kit
|
Facility
|
OP
|
$3,659.00
|
|
| Hospital Charge Code |
5707629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,024.52 |
| Max. Negotiated Rate |
$14,636.00 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,024.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,378.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,829.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,756.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.27
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,047.58
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,744.25
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,195.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,378.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,195.40
|
| Rate for Payer: The Alliance Commercial |
$14,636.00
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
Size 8 - Percutaneous Tracheostomy Kit
|
Facility
|
IP
|
$3,659.00
|
|
| Hospital Charge Code |
5707629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,792.91 |
| Max. Negotiated Rate |
$3,366.28 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.27
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,195.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,195.40
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
SIZER 390CC BREAST IMPLANT
|
Facility
|
IP
|
$963.00
|
|
| Hospital Charge Code |
2964640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.87 |
| Max. Negotiated Rate |
$885.96 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$577.80
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
SIZER 390CC BREAST IMPLANT
|
Facility
|
OP
|
$963.00
|
|
| Hospital Charge Code |
2964640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.64 |
| Max. Negotiated Rate |
$3,852.00 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Aetna Managed Medicare |
$269.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.89
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.25
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$625.95
|
| Rate for Payer: Quartz Medicare Advantage |
$577.80
|
| Rate for Payer: The Alliance Commercial |
$3,852.00
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
SIZER CAGE SCREW ECLIPSE AR-9401-08S
|
Facility
|
IP
|
$1,464.00
|
|
| Hospital Charge Code |
5563220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SIZER CAGE SCREW ECLIPSE AR-9401-08S
|
Facility
|
OP
|
$1,464.00
|
|
| Hospital Charge Code |
5563220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SIZER GRAFT LARGE 24MM - 38MM M0023632000211
|
Facility
|
IP
|
$213.00
|
|
| Hospital Charge Code |
5813673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
SIZER GRAFT LARGE 24MM - 38MM M0023632000211
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
5813673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
SIZER GRAFT SMALL 5MM - 24MM M0023632000201
|
Facility
|
IP
|
$213.00
|
|
| Hospital Charge Code |
5813672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
SIZER GRAFT SMALL 5MM - 24MM M0023632000201
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
5813672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Sjogern's Antibody (SSA)
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.47 |
| Max. Negotiated Rate |
$278.76 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.59
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$278.76
|
| Rate for Payer: Health EOS Commercial |
$269.67
|
| Rate for Payer: HFN Commercial |
$278.76
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: NAPHCARE Commercial |
$181.80
|
| Rate for Payer: Preferred Network Access Commercial |
$278.76
|
| Rate for Payer: Quartz Beloit One Network |
$148.47
|
| Rate for Payer: Quartz Commercial |
$181.80
|
| Rate for Payer: WEA Trust Commercial |
$166.65
|
| Rate for Payer: WPS Commercial |
$224.43
|
|
|
Sjogern's Antibody (SSA)
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Aetna Commercial |
$287.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.58
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$287.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.80
|
| Rate for Payer: Health EOS Commercial |
$275.73
|
| Rate for Payer: HFN Commercial |
$287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$287.85
|
| Rate for Payer: Quartz Beloit One Network |
$133.32
|
| Rate for Payer: Quartz Commercial |
$172.71
|
| Rate for Payer: The Alliance Commercial |
$151.50
|
| Rate for Payer: WEA Trust Commercial |
$166.65
|
| Rate for Payer: WPS Commercial |
$224.43
|
|
|
Sjogern's Antibody (SSA)
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$278.76 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.58
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$278.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.56
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$269.67
|
| Rate for Payer: HFN Commercial |
$278.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$278.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$148.47
|
| Rate for Payer: Quartz Commercial |
$196.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$227.25
|
| Rate for Payer: WEA Trust Commercial |
$166.65
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$224.43
|
|
|
Sjogern's Antibody (SS-A,SS-B)
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
983404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna Commercial |
$187.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$187.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.20
|
| Rate for Payer: Health EOS Commercial |
$179.27
|
| Rate for Payer: HFN Commercial |
$187.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Preferred Network Access Commercial |
$187.15
|
| Rate for Payer: Quartz Beloit One Network |
$86.68
|
| Rate for Payer: Quartz Commercial |
$112.29
|
| Rate for Payer: The Alliance Commercial |
$98.50
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
Sjogern's Antibody (SS-A,SS-B)
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
983404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
