|
WA1 IgG Antibody, IFA
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5355236
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$56.70
|
|
|
WAIS IV RECORD FORM
|
Facility
|
IP
|
$1,754.00
|
|
| Hospital Charge Code |
2972682
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$893.84 |
| Max. Negotiated Rate |
$1,678.23 |
| Rate for Payer: Aetna Commercial |
$1,641.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.80
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,678.23
|
| Rate for Payer: Health EOS Commercial |
$1,623.50
|
| Rate for Payer: HFN Commercial |
$1,678.23
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.23
|
| Rate for Payer: Quartz Beloit One Network |
$893.84
|
| Rate for Payer: Quartz Commercial |
$1,094.50
|
| Rate for Payer: WEA Trust Commercial |
$1,003.29
|
| Rate for Payer: WPS Commercial |
$1,351.11
|
|
|
WAIS IV RECORD FORM
|
Facility
|
OP
|
$1,754.00
|
|
| Hospital Charge Code |
2972682
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$510.76 |
| Max. Negotiated Rate |
$1,678.23 |
| Rate for Payer: Aetna Commercial |
$1,641.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.78
|
| Rate for Payer: Aetna Managed Medicare |
$510.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$912.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.80
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,678.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.83
|
| Rate for Payer: Health EOS Commercial |
$1,623.50
|
| Rate for Payer: HFN Commercial |
$1,678.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.12
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.23
|
| Rate for Payer: Quartz Beloit One Network |
$893.84
|
| Rate for Payer: Quartz Commercial |
$1,185.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,094.50
|
| Rate for Payer: The Alliance Commercial |
$912.08
|
| Rate for Payer: WEA Trust Commercial |
$1,003.29
|
| Rate for Payer: WPS Commercial |
$1,351.11
|
|
|
WAIS IV RESPONSE BOOKLET 2
|
Facility
|
IP
|
$940.00
|
|
| Hospital Charge Code |
2971755
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$479.02 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$586.56
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
WAIS IV RESPONSE BOOKLET 2
|
Facility
|
OP
|
$940.00
|
|
| Hospital Charge Code |
2971755
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Aetna Managed Medicare |
$273.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.08
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.20
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: NAPHCARE Commercial |
$586.56
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$635.44
|
| Rate for Payer: Quartz Medicare Advantage |
$586.56
|
| Rate for Payer: The Alliance Commercial |
$488.80
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
WALKER CAM #L4360
|
Facility
|
OP
|
$3,075.00
|
|
| Hospital Charge Code |
2974046
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$2,942.16 |
| Rate for Payer: Aetna Commercial |
$2,878.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,750.28
|
| Rate for Payer: Aetna Managed Medicare |
$895.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,078.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,599.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,535.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.94
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna Commercial |
$2,942.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,789.65
|
| Rate for Payer: Health EOS Commercial |
$2,846.22
|
| Rate for Payer: HFN Commercial |
$2,942.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,398.50
|
| Rate for Payer: Multiplan Commercial |
$2,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,918.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,942.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,567.02
|
| Rate for Payer: Quartz Commercial |
$2,078.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,918.80
|
| Rate for Payer: The Alliance Commercial |
$1,599.00
|
| Rate for Payer: WEA Trust Commercial |
$1,758.90
|
| Rate for Payer: WPS Commercial |
$2,368.67
|
|
|
WALKER CAM #L4360
|
Facility
|
IP
|
$3,075.00
|
|
| Hospital Charge Code |
2974046
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,567.02 |
| Max. Negotiated Rate |
$2,942.16 |
| Rate for Payer: Aetna Commercial |
$2,878.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,750.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.94
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna Commercial |
$2,942.16
|
| Rate for Payer: Health EOS Commercial |
$2,846.22
|
| Rate for Payer: HFN Commercial |
$2,942.16
|
| Rate for Payer: Multiplan Commercial |
$2,558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,942.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,567.02
|
| Rate for Payer: Quartz Commercial |
$1,918.80
|
| Rate for Payer: WEA Trust Commercial |
$1,758.90
|
| Rate for Payer: WPS Commercial |
$2,368.67
|
|
|
WALKER,INLINE AIR,CLOSED HEEL,M 15490006
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2974607
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
WALKER,INLINE AIR,CLOSED HEEL,M 15490006
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2974607
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.00
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$520.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
WALKER INLINE OPEN HEEL SMALL
|
Facility
|
OP
|
$999.00
|
|
| Hospital Charge Code |
2974606
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$290.91 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$675.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$519.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.42
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.22
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: NAPHCARE Commercial |
$623.38
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$675.32
|
| Rate for Payer: Quartz Medicare Advantage |
$623.38
|
| Rate for Payer: The Alliance Commercial |
$519.48
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
WALKER INLINE OPEN HEEL SMALL
|
Facility
|
IP
|
$999.00
|
|
| Hospital Charge Code |
2974606
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$509.09 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$623.38
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
WALKER PNEUMANTIC AIR SMALL 15490005
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2974605
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
WALKER PNEUMANTIC AIR SMALL 15490005
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2974605
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.00
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$520.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
WALKER PNEUMAT AIR LG 15490067
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2974604
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
WALKER PNEUMAT AIR LG 15490067
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2974604
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
WALKERS & CANES-SP #11458
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2974082
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
WALKERS & CANES-SP #11458
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2974082
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
WAND HALO COBLATION WEREWOLF (T & A) 72290134
|
Facility
|
OP
|
$3,314.00
|
|
| Hospital Charge Code |
5977632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.04 |
| Max. Negotiated Rate |
$3,170.84 |
| Rate for Payer: Aetna Commercial |
$3,101.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Aetna Managed Medicare |
$965.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,240.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,723.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,654.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.68
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,170.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,928.75
|
| Rate for Payer: Health EOS Commercial |
$3,067.44
|
| Rate for Payer: HFN Commercial |
$3,170.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,584.92
|
| Rate for Payer: Multiplan Commercial |
$2,757.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,067.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,170.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,688.81
|
| Rate for Payer: Quartz Commercial |
$2,240.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,067.94
|
| Rate for Payer: The Alliance Commercial |
$1,723.28
|
| Rate for Payer: WEA Trust Commercial |
$1,895.61
|
| Rate for Payer: WPS Commercial |
$2,552.77
|
|
|
WAND HALO COBLATION WEREWOLF (T & A) 72290134
|
Facility
|
IP
|
$3,314.00
|
|
| Hospital Charge Code |
5977632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,688.81 |
| Max. Negotiated Rate |
$3,170.84 |
| Rate for Payer: Aetna Commercial |
$3,101.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.68
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,170.84
|
| Rate for Payer: Health EOS Commercial |
$3,067.44
|
| Rate for Payer: HFN Commercial |
$3,170.84
|
| Rate for Payer: Multiplan Commercial |
$2,757.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,170.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,688.81
|
| Rate for Payer: Quartz Commercial |
$2,067.94
|
| Rate for Payer: WEA Trust Commercial |
$1,895.61
|
| Rate for Payer: WPS Commercial |
$2,552.77
|
|
|
WAND PROCISE MAX COBLATION WITH INTEGRATED CABLE (ADENOID) EICA8898-01
|
Facility
|
OP
|
$3,037.00
|
|
| Hospital Charge Code |
5861692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$2,905.80 |
| Rate for Payer: Aetna Commercial |
$2,842.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,716.29
|
| Rate for Payer: Aetna Managed Medicare |
$884.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,053.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,579.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.99
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,905.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,767.53
|
| Rate for Payer: Health EOS Commercial |
$2,811.05
|
| Rate for Payer: HFN Commercial |
$2,905.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,368.86
|
| Rate for Payer: Multiplan Commercial |
$2,526.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,895.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,905.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.66
|
| Rate for Payer: Quartz Commercial |
$2,053.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,895.09
|
| Rate for Payer: The Alliance Commercial |
$1,579.24
|
| Rate for Payer: WEA Trust Commercial |
$1,737.16
|
| Rate for Payer: WPS Commercial |
$2,339.40
|
|
|
WAND PROCISE MAX COBLATION WITH INTEGRATED CABLE (ADENOID) EICA8898-01
|
Facility
|
IP
|
$3,037.00
|
|
| Hospital Charge Code |
5861692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,547.66 |
| Max. Negotiated Rate |
$2,905.80 |
| Rate for Payer: Aetna Commercial |
$2,842.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,716.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.99
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,905.80
|
| Rate for Payer: Health EOS Commercial |
$2,811.05
|
| Rate for Payer: HFN Commercial |
$2,905.80
|
| Rate for Payer: Multiplan Commercial |
$2,526.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,905.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.66
|
| Rate for Payer: Quartz Commercial |
$1,895.09
|
| Rate for Payer: WEA Trust Commercial |
$1,737.16
|
| Rate for Payer: WPS Commercial |
$2,339.40
|
|
|
WAND PROCISE XP WITH INTEGRATED CABLES (T&A) EICA8872-01
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
5415485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna Commercial |
$2,925.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,795.00
|
| Rate for Payer: Aetna Managed Medicare |
$910.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,112.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,560.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,722.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$2,990.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,818.75
|
| Rate for Payer: Health EOS Commercial |
$2,892.50
|
| Rate for Payer: HFN Commercial |
$2,990.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,437.50
|
| Rate for Payer: Multiplan Commercial |
$2,600.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,950.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,990.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,592.50
|
| Rate for Payer: Quartz Commercial |
$2,112.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,950.00
|
| Rate for Payer: The Alliance Commercial |
$1,625.00
|
| Rate for Payer: WEA Trust Commercial |
$1,787.50
|
| Rate for Payer: WPS Commercial |
$2,407.19
|
|
|
WAND PROCISE XP WITH INTEGRATED CABLES (T&A) EICA8872-01
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
5415485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,592.50 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna Commercial |
$2,925.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,795.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,722.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$2,990.00
|
| Rate for Payer: Health EOS Commercial |
$2,892.50
|
| Rate for Payer: HFN Commercial |
$2,990.00
|
| Rate for Payer: Multiplan Commercial |
$2,600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,990.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,592.50
|
| Rate for Payer: Quartz Commercial |
$1,950.00
|
| Rate for Payer: WEA Trust Commercial |
$1,787.50
|
| Rate for Payer: WPS Commercial |
$2,407.19
|
|
|
WAND REFLEX ULTRA PLASMA COBLATION PTR (SINUS) EICA4835-01
|
Facility
|
IP
|
$2,570.00
|
|
| Hospital Charge Code |
3301462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,603.68
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
WAND REFLEX ULTRA PLASMA COBLATION PTR (SINUS) EICA4835-01
|
Facility
|
OP
|
$2,570.00
|
|
| Hospital Charge Code |
3301462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.38 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Aetna Managed Medicare |
$748.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,737.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,282.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,495.74
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,004.60
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,603.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,737.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,603.68
|
| Rate for Payer: The Alliance Commercial |
$1,336.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
