|
SYS REPOSITION PREVALON AIRTAP 7217
|
Facility
|
OP
|
$2,423.00
|
|
| Hospital Charge Code |
5414958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.58 |
| Max. Negotiated Rate |
$2,318.33 |
| Rate for Payer: Aetna Commercial |
$2,267.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,167.13
|
| Rate for Payer: Aetna Managed Medicare |
$705.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,637.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,259.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,335.56
|
| Rate for Payer: Cash Price |
$726.90
|
| Rate for Payer: Cigna Commercial |
$2,318.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,410.19
|
| Rate for Payer: Health EOS Commercial |
$2,242.73
|
| Rate for Payer: HFN Commercial |
$2,318.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,889.94
|
| Rate for Payer: Multiplan Commercial |
$2,015.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,511.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,318.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,234.76
|
| Rate for Payer: Quartz Commercial |
$1,637.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,511.95
|
| Rate for Payer: The Alliance Commercial |
$1,259.96
|
| Rate for Payer: WEA Trust Commercial |
$1,385.96
|
| Rate for Payer: WPS Commercial |
$1,866.44
|
|
|
SYSTEM 1 LAPIPLASTY (4HL CRV PLT X 2, 2.7X12MM LOCK SCREW X 5, 2.7X14MM LOCK SCREW X 4) SK12
|
Facility
|
IP
|
$27,986.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,261.67 |
| Max. Negotiated Rate |
$26,777.00 |
| Rate for Payer: Aetna Commercial |
$26,194.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,030.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,425.88
|
| Rate for Payer: Cash Price |
$8,395.80
|
| Rate for Payer: Cigna Commercial |
$26,777.00
|
| Rate for Payer: Health EOS Commercial |
$25,903.84
|
| Rate for Payer: HFN Commercial |
$26,777.00
|
| Rate for Payer: Multiplan Commercial |
$23,284.35
|
| Rate for Payer: Preferred Network Access Commercial |
$26,777.00
|
| Rate for Payer: Quartz Beloit One Network |
$14,261.67
|
| Rate for Payer: Quartz Commercial |
$17,463.26
|
| Rate for Payer: WEA Trust Commercial |
$16,007.99
|
| Rate for Payer: WPS Commercial |
$21,557.62
|
|
|
SYSTEM 1 LAPIPLASTY (4HL CRV PLT X 2, 2.7X12MM LOCK SCREW X 5, 2.7X14MM LOCK SCREW X 4) SK12
|
Facility
|
OP
|
$27,986.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,149.52 |
| Max. Negotiated Rate |
$26,777.00 |
| Rate for Payer: Aetna Commercial |
$26,194.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,030.68
|
| Rate for Payer: Aetna Managed Medicare |
$8,149.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,918.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,552.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,970.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,425.88
|
| Rate for Payer: Cash Price |
$8,395.80
|
| Rate for Payer: Cigna Commercial |
$26,777.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,287.85
|
| Rate for Payer: Health EOS Commercial |
$25,903.84
|
| Rate for Payer: HFN Commercial |
$26,777.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,829.08
|
| Rate for Payer: Multiplan Commercial |
$23,284.35
|
| Rate for Payer: NAPHCARE Commercial |
$17,463.26
|
| Rate for Payer: Preferred Network Access Commercial |
$26,777.00
|
| Rate for Payer: Quartz Beloit One Network |
$14,261.67
|
| Rate for Payer: Quartz Commercial |
$18,918.54
|
| Rate for Payer: Quartz Medicare Advantage |
$17,463.26
|
| Rate for Payer: The Alliance Commercial |
$14,552.72
|
| Rate for Payer: WEA Trust Commercial |
$16,007.99
|
| Rate for Payer: WPS Commercial |
$21,557.62
|
|
|
SYSTEM 2 LAPIPLASTY (4HL CRV PLT X 2, 2.7X12MM LOCK SCREW X 5, 2.7X14MM LOCK SCREW X 4) SK14
|
Facility
|
IP
|
$35,242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,959.32 |
| Max. Negotiated Rate |
$33,719.55 |
| Rate for Payer: Aetna Commercial |
$32,986.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,520.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,425.39
|
| Rate for Payer: Cash Price |
$10,572.60
|
| Rate for Payer: Cigna Commercial |
$33,719.55
|
| Rate for Payer: Health EOS Commercial |
$32,620.00
|
| Rate for Payer: HFN Commercial |
$33,719.55
|
| Rate for Payer: Multiplan Commercial |
$29,321.34
|
| Rate for Payer: Preferred Network Access Commercial |
$33,719.55
|
| Rate for Payer: Quartz Beloit One Network |
$17,959.32
|
| Rate for Payer: Quartz Commercial |
$21,991.01
|
| Rate for Payer: WEA Trust Commercial |
$20,158.42
|
| Rate for Payer: WPS Commercial |
$27,146.91
|
|
|
SYSTEM 2 LAPIPLASTY (4HL CRV PLT X 2, 2.7X12MM LOCK SCREW X 5, 2.7X14MM LOCK SCREW X 4) SK14
|
Facility
|
OP
|
$35,242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,262.47 |
| Max. Negotiated Rate |
$33,719.55 |
| Rate for Payer: Aetna Commercial |
$32,986.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,520.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,262.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,823.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,325.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,592.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,425.39
|
| Rate for Payer: Cash Price |
$10,572.60
|
| Rate for Payer: Cigna Commercial |
$33,719.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,510.84
|
| Rate for Payer: Health EOS Commercial |
$32,620.00
|
| Rate for Payer: HFN Commercial |
$33,719.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,488.76
|
| Rate for Payer: Multiplan Commercial |
$29,321.34
|
| Rate for Payer: NAPHCARE Commercial |
$21,991.01
|
| Rate for Payer: Preferred Network Access Commercial |
$33,719.55
|
| Rate for Payer: Quartz Beloit One Network |
$17,959.32
|
| Rate for Payer: Quartz Commercial |
$23,823.59
|
| Rate for Payer: Quartz Medicare Advantage |
$21,991.01
|
| Rate for Payer: The Alliance Commercial |
$18,325.84
|
| Rate for Payer: WEA Trust Commercial |
$20,158.42
|
| Rate for Payer: WPS Commercial |
$27,146.91
|
|
|
SYSTEM ABTHERA SENSA T.R.A.C. OPEN ABDOMINAL DRESSING M8275026/5
|
Facility
|
OP
|
$11,204.00
|
|
| Hospital Charge Code |
4640619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,262.60 |
| Max. Negotiated Rate |
$10,719.99 |
| Rate for Payer: Aetna Commercial |
$10,486.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,020.86
|
| Rate for Payer: Aetna Managed Medicare |
$3,262.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,573.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,826.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,593.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,175.64
|
| Rate for Payer: Cash Price |
$3,361.20
|
| Rate for Payer: Cigna Commercial |
$10,719.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,520.73
|
| Rate for Payer: Health EOS Commercial |
$10,370.42
|
| Rate for Payer: HFN Commercial |
$10,719.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,739.12
|
| Rate for Payer: Multiplan Commercial |
$9,321.73
|
| Rate for Payer: NAPHCARE Commercial |
$6,991.30
|
| Rate for Payer: Preferred Network Access Commercial |
$10,719.99
|
| Rate for Payer: Quartz Beloit One Network |
$5,709.56
|
| Rate for Payer: Quartz Commercial |
$7,573.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,991.30
|
| Rate for Payer: The Alliance Commercial |
$5,826.08
|
| Rate for Payer: WEA Trust Commercial |
$6,408.69
|
| Rate for Payer: WPS Commercial |
$8,630.44
|
|
|
SYSTEM ABTHERA SENSA T.R.A.C. OPEN ABDOMINAL DRESSING M8275026/5
|
Facility
|
IP
|
$11,204.00
|
|
| Hospital Charge Code |
4640619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,709.56 |
| Max. Negotiated Rate |
$10,719.99 |
| Rate for Payer: Aetna Commercial |
$10,486.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,020.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,175.64
|
| Rate for Payer: Cash Price |
$3,361.20
|
| Rate for Payer: Cigna Commercial |
$10,719.99
|
| Rate for Payer: Health EOS Commercial |
$10,370.42
|
| Rate for Payer: HFN Commercial |
$10,719.99
|
| Rate for Payer: Multiplan Commercial |
$9,321.73
|
| Rate for Payer: Preferred Network Access Commercial |
$10,719.99
|
| Rate for Payer: Quartz Beloit One Network |
$5,709.56
|
| Rate for Payer: Quartz Commercial |
$6,991.30
|
| Rate for Payer: WEA Trust Commercial |
$6,408.69
|
| Rate for Payer: WPS Commercial |
$8,630.44
|
|
|
SYSTEM COPE CATHETER INTRODUCTION G03407
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.94 |
| Max. Negotiated Rate |
$1,235.23 |
| Rate for Payer: Aetna Commercial |
$1,208.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.67
|
| Rate for Payer: Aetna Managed Medicare |
$375.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.60
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.36
|
| Rate for Payer: Health EOS Commercial |
$1,194.95
|
| Rate for Payer: HFN Commercial |
$1,235.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,006.98
|
| Rate for Payer: Multiplan Commercial |
$1,074.11
|
| Rate for Payer: NAPHCARE Commercial |
$805.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.23
|
| Rate for Payer: Quartz Beloit One Network |
$657.89
|
| Rate for Payer: Quartz Commercial |
$872.72
|
| Rate for Payer: Quartz Medicare Advantage |
$805.58
|
| Rate for Payer: The Alliance Commercial |
$671.32
|
| Rate for Payer: WEA Trust Commercial |
$738.45
|
| Rate for Payer: WPS Commercial |
$994.46
|
|
|
SYSTEM COPE CATHETER INTRODUCTION G03407
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$657.89 |
| Max. Negotiated Rate |
$1,235.23 |
| Rate for Payer: Aetna Commercial |
$1,208.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.60
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: Health EOS Commercial |
$1,194.95
|
| Rate for Payer: HFN Commercial |
$1,235.23
|
| Rate for Payer: Multiplan Commercial |
$1,074.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.23
|
| Rate for Payer: Quartz Beloit One Network |
$657.89
|
| Rate for Payer: Quartz Commercial |
$805.58
|
| Rate for Payer: WEA Trust Commercial |
$738.45
|
| Rate for Payer: WPS Commercial |
$994.46
|
|
|
SYSTEM CUSTOM PERFUSION VACUUM 0Y35R
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
3792827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
SYSTEM CUSTOM PERFUSION VACUUM 0Y35R
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
3792827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$310.96
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
Systemic Lupus (SLE) Comprehensive Diagnostics Panel
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
3398191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$108.58
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
Systemic Lupus (SLE) Comprehensive Diagnostics Panel
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
3398191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$117.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$50.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: United Healthcare PPO |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: Wellcare Medicare |
$12.57
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
Systemic Lupus (SLE) Comprehensive Diagnostics Panel
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
3398191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$49.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$55.32
|
|
|
SYSTEM IRRIGATION IRRISEPT IRRISEPT
|
Facility
|
OP
|
$1,129.00
|
|
| Hospital Charge Code |
5349335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.76 |
| Max. Negotiated Rate |
$1,080.23 |
| Rate for Payer: Aetna Commercial |
$1,056.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Aetna Managed Medicare |
$328.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$763.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$587.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$563.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.30
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,080.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$657.08
|
| Rate for Payer: Health EOS Commercial |
$1,045.00
|
| Rate for Payer: HFN Commercial |
$1,080.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$880.62
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: NAPHCARE Commercial |
$704.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,080.23
|
| Rate for Payer: Quartz Beloit One Network |
$575.34
|
| Rate for Payer: Quartz Commercial |
$763.20
|
| Rate for Payer: Quartz Medicare Advantage |
$704.50
|
| Rate for Payer: The Alliance Commercial |
$587.08
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$869.67
|
|
|
SYSTEM IRRIGATION IRRISEPT IRRISEPT
|
Facility
|
IP
|
$1,129.00
|
|
| Hospital Charge Code |
5349335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.34 |
| Max. Negotiated Rate |
$1,080.23 |
| Rate for Payer: Aetna Commercial |
$1,056.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.30
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,080.23
|
| Rate for Payer: Health EOS Commercial |
$1,045.00
|
| Rate for Payer: HFN Commercial |
$1,080.23
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,080.23
|
| Rate for Payer: Quartz Beloit One Network |
$575.34
|
| Rate for Payer: Quartz Commercial |
$704.50
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$869.67
|
|
|
SYSTEM MAX CORE BIOPSY 18 X 20CM (GENERAL) MC1820
|
Facility
|
IP
|
$861.00
|
|
| Hospital Charge Code |
2969353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.77 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$537.26
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
SYSTEM MAX CORE BIOPSY 18 X 20CM (GENERAL) MC1820
|
Facility
|
OP
|
$861.00
|
|
| Hospital Charge Code |
2969353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.72 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Aetna Managed Medicare |
$250.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$429.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.10
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.58
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: NAPHCARE Commercial |
$537.26
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$582.04
|
| Rate for Payer: Quartz Medicare Advantage |
$537.26
|
| Rate for Payer: The Alliance Commercial |
$447.72
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
SYSTEM MAX CORE BIOPSY 18 X 25CM (URO) MC1825
|
Facility
|
OP
|
$2,998.00
|
|
| Hospital Charge Code |
3825392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$873.02 |
| Max. Negotiated Rate |
$2,868.49 |
| Rate for Payer: Aetna Commercial |
$2,806.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,681.41
|
| Rate for Payer: Aetna Managed Medicare |
$873.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,026.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,558.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,496.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,652.50
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cigna Commercial |
$2,868.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,744.84
|
| Rate for Payer: Health EOS Commercial |
$2,774.95
|
| Rate for Payer: HFN Commercial |
$2,868.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,338.44
|
| Rate for Payer: Multiplan Commercial |
$2,494.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,870.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,868.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.78
|
| Rate for Payer: Quartz Commercial |
$2,026.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,870.75
|
| Rate for Payer: The Alliance Commercial |
$1,558.96
|
| Rate for Payer: WEA Trust Commercial |
$1,714.86
|
| Rate for Payer: WPS Commercial |
$2,309.36
|
|
|
SYSTEM MAX CORE BIOPSY 18 X 25CM (URO) MC1825
|
Facility
|
IP
|
$2,998.00
|
|
| Hospital Charge Code |
3825392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,527.78 |
| Max. Negotiated Rate |
$2,868.49 |
| Rate for Payer: Aetna Commercial |
$2,806.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,681.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,652.50
|
| Rate for Payer: Cash Price |
$899.40
|
| Rate for Payer: Cigna Commercial |
$2,868.49
|
| Rate for Payer: Health EOS Commercial |
$2,774.95
|
| Rate for Payer: HFN Commercial |
$2,868.49
|
| Rate for Payer: Multiplan Commercial |
$2,494.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,868.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.78
|
| Rate for Payer: Quartz Commercial |
$1,870.75
|
| Rate for Payer: WEA Trust Commercial |
$1,714.86
|
| Rate for Payer: WPS Commercial |
$2,309.36
|
|
|
SYSTEM PREVENA CUSTOMIZABLE PRE4001US
|
Facility
|
OP
|
$4,940.00
|
|
| Hospital Charge Code |
5074884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,438.53 |
| Max. Negotiated Rate |
$4,726.59 |
| Rate for Payer: Aetna Commercial |
$4,623.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,418.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,438.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,339.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,568.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,466.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,722.93
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$4,726.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,875.08
|
| Rate for Payer: Health EOS Commercial |
$4,572.46
|
| Rate for Payer: HFN Commercial |
$4,726.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,853.20
|
| Rate for Payer: Multiplan Commercial |
$4,110.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,726.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,517.42
|
| Rate for Payer: Quartz Commercial |
$3,339.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,082.56
|
| Rate for Payer: The Alliance Commercial |
$2,568.80
|
| Rate for Payer: WEA Trust Commercial |
$2,825.68
|
| Rate for Payer: WPS Commercial |
$3,805.28
|
|
|
SYSTEM PREVENA CUSTOMIZABLE PRE4001US
|
Facility
|
IP
|
$4,940.00
|
|
| Hospital Charge Code |
5074884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,517.42 |
| Max. Negotiated Rate |
$4,726.59 |
| Rate for Payer: Aetna Commercial |
$4,623.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,418.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,722.93
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$4,726.59
|
| Rate for Payer: Health EOS Commercial |
$4,572.46
|
| Rate for Payer: HFN Commercial |
$4,726.59
|
| Rate for Payer: Multiplan Commercial |
$4,110.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4,726.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,517.42
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: WEA Trust Commercial |
$2,825.68
|
| Rate for Payer: WPS Commercial |
$3,805.28
|
|
|
SYSTEM SEATED POSITIONING 7530
|
Facility
|
OP
|
$1,540.00
|
|
| Hospital Charge Code |
5459574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.45 |
| Max. Negotiated Rate |
$1,473.47 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.38
|
| Rate for Payer: Aetna Managed Medicare |
$448.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,041.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.85
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$1,473.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$896.28
|
| Rate for Payer: Health EOS Commercial |
$1,425.42
|
| Rate for Payer: HFN Commercial |
$1,473.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.20
|
| Rate for Payer: Multiplan Commercial |
$1,281.28
|
| Rate for Payer: NAPHCARE Commercial |
$960.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.47
|
| Rate for Payer: Quartz Beloit One Network |
$784.78
|
| Rate for Payer: Quartz Commercial |
$1,041.04
|
| Rate for Payer: Quartz Medicare Advantage |
$960.96
|
| Rate for Payer: The Alliance Commercial |
$800.80
|
| Rate for Payer: WEA Trust Commercial |
$880.88
|
| Rate for Payer: WPS Commercial |
$1,186.26
|
|
|
SYSTEM SEATED POSITIONING 7530
|
Facility
|
IP
|
$1,540.00
|
|
| Hospital Charge Code |
5459574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.78 |
| Max. Negotiated Rate |
$1,473.47 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.85
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$1,473.47
|
| Rate for Payer: Health EOS Commercial |
$1,425.42
|
| Rate for Payer: HFN Commercial |
$1,473.47
|
| Rate for Payer: Multiplan Commercial |
$1,281.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.47
|
| Rate for Payer: Quartz Beloit One Network |
$784.78
|
| Rate for Payer: Quartz Commercial |
$960.96
|
| Rate for Payer: WEA Trust Commercial |
$880.88
|
| Rate for Payer: WPS Commercial |
$1,186.26
|
|
|
SYSTEM STRATOS ENDOSCOPIC CARPAL TUNNEL RELEASE 5500
|
Facility
|
IP
|
$9,102.00
|
|
| Hospital Charge Code |
4508723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,638.38 |
| Max. Negotiated Rate |
$8,708.79 |
| Rate for Payer: Aetna Commercial |
$8,519.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,140.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,017.02
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,708.79
|
| Rate for Payer: Health EOS Commercial |
$8,424.81
|
| Rate for Payer: HFN Commercial |
$8,708.79
|
| Rate for Payer: Multiplan Commercial |
$7,572.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,708.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,638.38
|
| Rate for Payer: Quartz Commercial |
$5,679.65
|
| Rate for Payer: WEA Trust Commercial |
$5,206.34
|
| Rate for Payer: WPS Commercial |
$7,011.27
|
|
