|
Whitacre Spinal Ndl 22Ga x 3.5 7080""
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
3101768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
Whitacre Spinal Ndl 22Ga x 3.5 7080""
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
3101768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
White Blood Count
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$2.64
|
| Rate for Payer: Anthem Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.64
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.64
|
| Rate for Payer: Health EOS Commercial |
$59.62
|
| Rate for Payer: HFN Commercial |
$62.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$3.96
|
| Rate for Payer: Preferred Network Access Commercial |
$62.24
|
| Rate for Payer: Quartz Beloit One Network |
$28.83
|
| Rate for Payer: Quartz Commercial |
$37.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2.64
|
| Rate for Payer: The Alliance Commercial |
$10.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.64
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$11.62
|
|
|
White Blood Count
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
White Blood Count
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$2.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.39
|
| Rate for Payer: Anthem Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.64
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.64
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$3.96
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$42.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2.64
|
| Rate for Payer: The Alliance Commercial |
$10.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.64
|
| Rate for Payer: United Healthcare PPO |
$49.14
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: Wellcare Medicare |
$2.64
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
WICKS POPE EAR #7014-0095
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2969529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
WICKS POPE EAR #7014-0095
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2969529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Wilson Disease Full Gene Analysis
|
Facility
|
IP
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,451.34 |
| Max. Negotiated Rate |
$2,724.97 |
| Rate for Payer: Aetna Commercial |
$2,665.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,547.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,569.82
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,724.97
|
| Rate for Payer: Health EOS Commercial |
$2,636.11
|
| Rate for Payer: HFN Commercial |
$2,724.97
|
| Rate for Payer: Multiplan Commercial |
$2,369.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.34
|
| Rate for Payer: Quartz Commercial |
$1,777.15
|
| Rate for Payer: WEA Trust Commercial |
$1,629.06
|
| Rate for Payer: WPS Commercial |
$2,193.81
|
|
|
Wilson Disease Full Gene Analysis
|
Professional
|
Both
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$2,813.82 |
| Rate for Payer: Aetna Commercial |
$2,813.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,547.25
|
| Rate for Payer: Aetna Managed Medicare |
$294.20
|
| Rate for Payer: Anthem Medicare Advantage |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.20
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,813.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,480.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.20
|
| Rate for Payer: Health EOS Commercial |
$2,695.35
|
| Rate for Payer: HFN Commercial |
$2,813.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,038.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.20
|
| Rate for Payer: Multiplan Commercial |
$2,369.54
|
| Rate for Payer: NAPHCARE Commercial |
$441.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,813.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.24
|
| Rate for Payer: Quartz Commercial |
$1,688.29
|
| Rate for Payer: Quartz Medicare Advantage |
$294.20
|
| Rate for Payer: The Alliance Commercial |
$1,162.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.20
|
| Rate for Payer: WEA Trust Commercial |
$1,629.06
|
| Rate for Payer: WPS Commercial |
$1,294.46
|
|
|
Wilson Disease Full Gene Analysis
|
Facility
|
OP
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$2,724.97 |
| Rate for Payer: Aetna Commercial |
$2,665.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,547.25
|
| Rate for Payer: Aetna Managed Medicare |
$294.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$514.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$488.36
|
| Rate for Payer: Anthem Medicare Advantage |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,569.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.20
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,724.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,657.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.20
|
| Rate for Payer: Health EOS Commercial |
$2,636.11
|
| Rate for Payer: HFN Commercial |
$2,724.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.20
|
| Rate for Payer: Multiplan Commercial |
$2,369.54
|
| Rate for Payer: NAPHCARE Commercial |
$441.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.34
|
| Rate for Payer: Quartz Commercial |
$1,925.25
|
| Rate for Payer: Quartz Medicare Advantage |
$294.20
|
| Rate for Payer: The Alliance Commercial |
$1,176.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.20
|
| Rate for Payer: United Healthcare PPO |
$2,221.44
|
| Rate for Payer: WEA Trust Commercial |
$1,629.06
|
| Rate for Payer: Wellcare Medicare |
$294.20
|
| Rate for Payer: WPS Commercial |
$2,193.81
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
WIPES EXFO
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2970883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$152.36
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
WIPES EXFO
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2970883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
WIPE SKIN BARRIER GEL 7917
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
2963504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
WIPE SKIN BARRIER GEL 7917
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
2963504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Wire .014 Asahi Regalia X5 300CM
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.72 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$697.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,868.88
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.10
|
| Rate for Payer: The Alliance Commercial |
$1,245.92
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
Wire .014 Asahi Regalia X5 300CM
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,495.10
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
Wire .014 Asato X5 300CM
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.72 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$697.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,868.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.10
|
| Rate for Payer: The Alliance Commercial |
$1,245.92
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
Wire .014 Asato X5 300CM
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,495.10
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$80.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$172.22
|
| Rate for Payer: The Alliance Commercial |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
