|
BASKET ZERO TIP 3.0 X 120 M0063901030
|
Facility
|
IP
|
$2,591.00
|
|
| Hospital Charge Code |
2964805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.37 |
| Max. Negotiated Rate |
$2,479.07 |
| Rate for Payer: Aetna Commercial |
$2,425.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.16
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,479.07
|
| Rate for Payer: Health EOS Commercial |
$2,398.23
|
| Rate for Payer: HFN Commercial |
$2,479.07
|
| Rate for Payer: Multiplan Commercial |
$2,155.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.37
|
| Rate for Payer: Quartz Commercial |
$1,616.78
|
| Rate for Payer: WEA Trust Commercial |
$1,482.05
|
| Rate for Payer: WPS Commercial |
$1,995.85
|
|
|
BASKET ZERO TIP 3.0 X 120 M0063901030
|
Facility
|
OP
|
$2,591.00
|
|
| Hospital Charge Code |
2964805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,479.07 |
| Rate for Payer: Aetna Commercial |
$2,425.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.39
|
| Rate for Payer: Aetna Managed Medicare |
$754.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,751.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,347.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,293.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.16
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,479.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,507.96
|
| Rate for Payer: Health EOS Commercial |
$2,398.23
|
| Rate for Payer: HFN Commercial |
$2,479.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,020.98
|
| Rate for Payer: Multiplan Commercial |
$2,155.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,616.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.37
|
| Rate for Payer: Quartz Commercial |
$1,751.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,616.78
|
| Rate for Payer: The Alliance Commercial |
$1,347.32
|
| Rate for Payer: WEA Trust Commercial |
$1,482.05
|
| Rate for Payer: WPS Commercial |
$1,995.85
|
|
|
BASKET ZERO TIP KNOT 1.9 X 120CM M0063901050
|
Facility
|
IP
|
$3,031.00
|
|
| Hospital Charge Code |
4594907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,544.60 |
| Max. Negotiated Rate |
$2,900.06 |
| Rate for Payer: Aetna Commercial |
$2,837.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.69
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,900.06
|
| Rate for Payer: Health EOS Commercial |
$2,805.49
|
| Rate for Payer: HFN Commercial |
$2,900.06
|
| Rate for Payer: Multiplan Commercial |
$2,521.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.60
|
| Rate for Payer: Quartz Commercial |
$1,891.34
|
| Rate for Payer: WEA Trust Commercial |
$1,733.73
|
| Rate for Payer: WPS Commercial |
$2,334.78
|
|
|
BASKET ZERO TIP KNOT 1.9 X 120CM M0063901050
|
Facility
|
OP
|
$3,031.00
|
|
| Hospital Charge Code |
4594907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$2,900.06 |
| Rate for Payer: Aetna Commercial |
$2,837.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.93
|
| Rate for Payer: Aetna Managed Medicare |
$882.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,048.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,576.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,513.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.69
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,900.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,764.04
|
| Rate for Payer: Health EOS Commercial |
$2,805.49
|
| Rate for Payer: HFN Commercial |
$2,900.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,364.18
|
| Rate for Payer: Multiplan Commercial |
$2,521.79
|
| Rate for Payer: NAPHCARE Commercial |
$1,891.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.60
|
| Rate for Payer: Quartz Commercial |
$2,048.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,891.34
|
| Rate for Payer: The Alliance Commercial |
$1,576.12
|
| Rate for Payer: WEA Trust Commercial |
$1,733.73
|
| Rate for Payer: WPS Commercial |
$2,334.78
|
|
|
BASKET ZERO TIP KNOT 2.4FR X 120CM M0063901010
|
Facility
|
OP
|
$2,792.00
|
|
| Hospital Charge Code |
4520078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$813.03 |
| Max. Negotiated Rate |
$2,671.39 |
| Rate for Payer: Aetna Commercial |
$2,613.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,497.16
|
| Rate for Payer: Aetna Managed Medicare |
$813.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,887.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,393.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.95
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$2,671.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,624.94
|
| Rate for Payer: Health EOS Commercial |
$2,584.28
|
| Rate for Payer: HFN Commercial |
$2,671.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,177.76
|
| Rate for Payer: Multiplan Commercial |
$2,322.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,742.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.80
|
| Rate for Payer: Quartz Commercial |
$1,887.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,742.21
|
| Rate for Payer: The Alliance Commercial |
$1,451.84
|
| Rate for Payer: WEA Trust Commercial |
$1,597.02
|
| Rate for Payer: WPS Commercial |
$2,150.68
|
|
|
BASKET ZERO TIP KNOT 2.4FR X 120CM M0063901010
|
Facility
|
IP
|
$2,792.00
|
|
| Hospital Charge Code |
4520078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,422.80 |
| Max. Negotiated Rate |
$2,671.39 |
| Rate for Payer: Aetna Commercial |
$2,613.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,497.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.95
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$2,671.39
|
| Rate for Payer: Health EOS Commercial |
$2,584.28
|
| Rate for Payer: HFN Commercial |
$2,671.39
|
| Rate for Payer: Multiplan Commercial |
$2,322.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.80
|
| Rate for Payer: Quartz Commercial |
$1,742.21
|
| Rate for Payer: WEA Trust Commercial |
$1,597.02
|
| Rate for Payer: WPS Commercial |
$2,150.68
|
|
|
BATH SITZ MAUVE
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2969213
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
BATH SITZ MAUVE
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2969213
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Battery for Hearing Device
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS V5266
|
| Hospital Charge Code |
3243657
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: United Healthcare PPO |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Battery for Hearing Device
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS V5266
|
| Hospital Charge Code |
3243657
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Battery for Hearing Device
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS V5266
|
| Hospital Charge Code |
3243657
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$35.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.46
|
| Rate for Payer: Health EOS Commercial |
$34.07
|
| Rate for Payer: HFN Commercial |
$35.57
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$35.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.47
|
| Rate for Payer: Quartz Commercial |
$21.34
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Baxter 1.5% 2L Dianel Ultrabag
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
3603566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Baxter 1.5% 2L Dianel Ultrabag
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
3603566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$44.72
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Baxter Mini Caps
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3603564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Baxter Mini Caps
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3603564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Baxter Transfer Set
|
Facility
|
OP
|
$379.00
|
|
| Hospital Charge Code |
3603565
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Aetna Managed Medicare |
$110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$197.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.58
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.62
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: NAPHCARE Commercial |
$236.50
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: Quartz Medicare Advantage |
$236.50
|
| Rate for Payer: The Alliance Commercial |
$197.08
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
Baxter Transfer Set
|
Facility
|
IP
|
$379.00
|
|
| Hospital Charge Code |
3603565
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$193.14 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$236.50
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
BCE Abdomen Biopsy
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 49180 TC
|
| Hospital Charge Code |
5418646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$506.98 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,629.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.15
|
| Rate for Payer: Aetna Managed Medicare |
$506.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.64
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,665.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,611.47
|
| Rate for Payer: HFN Commercial |
$1,665.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.98
|
| Rate for Payer: Multiplan Commercial |
$1,448.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.79
|
| Rate for Payer: Quartz Beloit One Network |
$887.21
|
| Rate for Payer: Quartz Commercial |
$1,176.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,086.38
|
| Rate for Payer: The Alliance Commercial |
$905.32
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$995.85
|
| Rate for Payer: WPS Commercial |
$1,341.09
|
|
|
BCE Abdomen Biopsy
|
Professional
|
Both
|
$1,741.00
|
|
|
Service Code
|
CPT 49180 TC
|
| Hospital Charge Code |
5418646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.66 |
| Max. Negotiated Rate |
$1,720.11 |
| Rate for Payer: Aetna Commercial |
$1,720.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.15
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,720.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,086.38
|
| Rate for Payer: Health EOS Commercial |
$1,647.68
|
| Rate for Payer: HFN Commercial |
$1,720.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$293.65
|
| Rate for Payer: Multiplan Commercial |
$1,448.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,720.11
|
| Rate for Payer: Quartz Beloit One Network |
$796.68
|
| Rate for Payer: Quartz Commercial |
$1,032.06
|
| Rate for Payer: The Alliance Commercial |
$905.32
|
| Rate for Payer: United Healthcare Medicaid |
$158.66
|
| Rate for Payer: WEA Trust Commercial |
$995.85
|
| Rate for Payer: WPS Commercial |
$1,341.09
|
|
|
BCE Abdomen Biopsy
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 49180 TC
|
| Hospital Charge Code |
5418646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$1,665.79 |
| Rate for Payer: Aetna Commercial |
$1,629.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.64
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,665.79
|
| Rate for Payer: Health EOS Commercial |
$1,611.47
|
| Rate for Payer: HFN Commercial |
$1,665.79
|
| Rate for Payer: Multiplan Commercial |
$1,448.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.79
|
| Rate for Payer: Quartz Beloit One Network |
$887.21
|
| Rate for Payer: Quartz Commercial |
$1,086.38
|
| Rate for Payer: WEA Trust Commercial |
$995.85
|
| Rate for Payer: WPS Commercial |
$1,341.09
|
|
|
BCE Asp/Inj, Thyroid Cyst
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
CPT 60300 TC
|
| Hospital Charge Code |
5484990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.40 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Aetna Managed Medicare |
$195.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.38
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$453.60
|
| Rate for Payer: Quartz Medicare Advantage |
$418.70
|
| Rate for Payer: The Alliance Commercial |
$348.92
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
BCE Asp/Inj, Thyroid Cyst
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 60300 TC
|
| Hospital Charge Code |
5484990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$341.94 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$418.70
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
BCE Asp/Inj, Thyroid Cyst
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 60300 TC
|
| Hospital Charge Code |
5484990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.85 |
| Max. Negotiated Rate |
$662.95 |
| Rate for Payer: Aetna Commercial |
$662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.70
|
| Rate for Payer: Health EOS Commercial |
$635.03
|
| Rate for Payer: HFN Commercial |
$662.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.49
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$662.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.05
|
| Rate for Payer: Quartz Commercial |
$397.77
|
| Rate for Payer: The Alliance Commercial |
$348.92
|
| Rate for Payer: United Healthcare Medicaid |
$77.85
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
BCE Axumin
|
Professional
|
Both
|
$1,163.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5454652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$532.19 |
| Max. Negotiated Rate |
$1,149.04 |
| Rate for Payer: Aetna Commercial |
$1,149.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,040.19
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cigna Commercial |
$1,149.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$604.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$725.71
|
| Rate for Payer: Health EOS Commercial |
$1,100.66
|
| Rate for Payer: HFN Commercial |
$1,149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$729.75
|
| Rate for Payer: Multiplan Commercial |
$967.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,149.04
|
| Rate for Payer: Quartz Beloit One Network |
$532.19
|
| Rate for Payer: Quartz Commercial |
$689.43
|
| Rate for Payer: The Alliance Commercial |
$604.76
|
| Rate for Payer: WEA Trust Commercial |
$665.24
|
| Rate for Payer: WPS Commercial |
$895.86
|
|
|
BCE Axumin
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5454652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$592.66 |
| Max. Negotiated Rate |
$1,112.76 |
| Rate for Payer: Aetna Commercial |
$1,088.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,040.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.05
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cigna Commercial |
$1,112.76
|
| Rate for Payer: Health EOS Commercial |
$1,076.47
|
| Rate for Payer: HFN Commercial |
$1,112.76
|
| Rate for Payer: Multiplan Commercial |
$967.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,112.76
|
| Rate for Payer: Quartz Beloit One Network |
$592.66
|
| Rate for Payer: Quartz Commercial |
$725.71
|
| Rate for Payer: WEA Trust Commercial |
$665.24
|
| Rate for Payer: WPS Commercial |
$895.86
|
|
