|
Barewire for NAVG Filter
|
Facility
|
OP
|
$2,215.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5460726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$8,860.00 |
| Rate for Payer: Aetna Commercial |
$1,993.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.90
|
| Rate for Payer: Aetna Managed Medicare |
$620.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.95
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,037.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,239.51
|
| Rate for Payer: Health EOS Commercial |
$1,971.35
|
| Rate for Payer: HFN Commercial |
$2,037.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,661.25
|
| Rate for Payer: Multiplan Commercial |
$1,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.35
|
| Rate for Payer: Quartz Commercial |
$1,439.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.00
|
| Rate for Payer: The Alliance Commercial |
$8,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.25
|
| Rate for Payer: WPS Commercial |
$1,640.65
|
|
|
BARI-AIR THERAPY BED
|
Facility
|
IP
|
$2,829.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964100
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,386.21 |
| Max. Negotiated Rate |
$2,602.68 |
| Rate for Payer: Aetna Commercial |
$2,546.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,499.37
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,602.68
|
| Rate for Payer: Health EOS Commercial |
$2,517.81
|
| Rate for Payer: HFN Commercial |
$2,602.68
|
| Rate for Payer: Multiplan Commercial |
$2,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,697.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,602.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.21
|
| Rate for Payer: Quartz Commercial |
$1,697.40
|
| Rate for Payer: WEA Trust Commercial |
$1,555.95
|
| Rate for Payer: WPS Commercial |
$2,095.44
|
|
|
BARI-AIR THERAPY BED
|
Facility
|
OP
|
$2,829.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964100
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$792.12 |
| Max. Negotiated Rate |
$11,316.00 |
| Rate for Payer: Aetna Commercial |
$2,546.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.94
|
| Rate for Payer: Aetna Managed Medicare |
$792.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,838.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,414.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,357.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,499.37
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,602.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.11
|
| Rate for Payer: Health EOS Commercial |
$2,517.81
|
| Rate for Payer: HFN Commercial |
$2,602.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,121.75
|
| Rate for Payer: Multiplan Commercial |
$2,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,697.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,602.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.21
|
| Rate for Payer: Quartz Commercial |
$1,838.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,697.40
|
| Rate for Payer: The Alliance Commercial |
$11,316.00
|
| Rate for Payer: WEA Trust Commercial |
$1,555.95
|
| Rate for Payer: WPS Commercial |
$2,095.44
|
|
|
Bariatric Ezio
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
3040373
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$74.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$1,064.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Bariatric Ezio
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
3040373
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
BARIATRIC W/SCALES
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$769.30 |
| Max. Negotiated Rate |
$1,444.40 |
| Rate for Payer: Aetna Commercial |
$1,413.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.10
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,444.40
|
| Rate for Payer: Health EOS Commercial |
$1,397.30
|
| Rate for Payer: HFN Commercial |
$1,444.40
|
| Rate for Payer: Multiplan Commercial |
$1,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$942.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.40
|
| Rate for Payer: Quartz Beloit One Network |
$769.30
|
| Rate for Payer: Quartz Commercial |
$942.00
|
| Rate for Payer: WEA Trust Commercial |
$863.50
|
| Rate for Payer: WPS Commercial |
$1,162.90
|
|
|
BARIATRIC W/SCALES
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$6,280.00 |
| Rate for Payer: Aetna Commercial |
$1,413.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.20
|
| Rate for Payer: Aetna Managed Medicare |
$439.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,020.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$753.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.10
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,444.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$878.57
|
| Rate for Payer: Health EOS Commercial |
$1,397.30
|
| Rate for Payer: HFN Commercial |
$1,444.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,177.50
|
| Rate for Payer: Multiplan Commercial |
$1,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$942.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.40
|
| Rate for Payer: Quartz Beloit One Network |
$769.30
|
| Rate for Payer: Quartz Commercial |
$1,020.50
|
| Rate for Payer: Quartz Medicare Advantage |
$942.00
|
| Rate for Payer: The Alliance Commercial |
$6,280.00
|
| Rate for Payer: WEA Trust Commercial |
$863.50
|
| Rate for Payer: WPS Commercial |
$1,162.90
|
|
|
BARRIER CTF CONVEX SENSURA 16931
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
5547235
|
|
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
|
|
|
BARRIER CTF CONVEX SENSURA 16931
|
Facility
|
IP
|
$213.00
|
|
| Hospital Charge Code |
5547235
|
|
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
|
|
|
BARRIER FILM NO STING WIPE 3344
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS A4414
|
| Hospital Charge Code |
2974355
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$64.80
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
BARRIER FILM NO STING WIPE 3344
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS A4414
|
| Hospital Charge Code |
2974355
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$30.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.44
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$70.20
|
| Rate for Payer: Quartz Medicare Advantage |
$64.80
|
| Rate for Payer: The Alliance Commercial |
$432.00
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
BARRIER FLANGE CTF 1.75 15602"
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4594656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$33.60
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
BARRIER FLANGE CTF 1.75 15602"
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4594656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
BARRIER HOLLISTER CTF 2.25 11203"
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4595817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
BARRIER HOLLISTER CTF 2.25 11203"
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4595817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
BARRIER RING ADAPT CONVEX 30MM 79530
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969212
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BARRIER RING ADAPT CONVEX 30MM 79530
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969212
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BARRIER RING ADAPT CONVEX 40MM 79540
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969211
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
BARRIER RING ADAPT CONVEX 40MM 79540
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969211
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
BARRIER WIPE NO STING 59420600
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2963786
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
BARRIER WIPE NO STING 59420600
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2963786
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
BARTHOLIN CYST MARSUPIALIZATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
BARTHOLIN CYST MARSUPIALIZATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Bartonella DNA, Qualitative PCR
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 87471
|
| Hospital Charge Code |
5162611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$357.88 |
| Rate for Payer: Aetna Commercial |
$350.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.17
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$357.88
|
| Rate for Payer: Health EOS Commercial |
$346.21
|
| Rate for Payer: HFN Commercial |
$357.88
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: NAPHCARE Commercial |
$233.40
|
| Rate for Payer: Preferred Network Access Commercial |
$357.88
|
| Rate for Payer: Quartz Beloit One Network |
$190.61
|
| Rate for Payer: Quartz Commercial |
$233.40
|
| Rate for Payer: WEA Trust Commercial |
$213.95
|
| Rate for Payer: WPS Commercial |
$288.13
|
|
|
Bartonella DNA, Qualitative PCR
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 87471
|
| Hospital Charge Code |
5162611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna Commercial |
$369.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.54
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$369.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.40
|
| Rate for Payer: Health EOS Commercial |
$353.99
|
| Rate for Payer: HFN Commercial |
$369.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.55
|
| Rate for Payer: Quartz Beloit One Network |
$171.16
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: The Alliance Commercial |
$194.50
|
| Rate for Payer: WEA Trust Commercial |
$213.95
|
| Rate for Payer: WPS Commercial |
$288.13
|
|
