|
BINDER ABDOMINAL 12 4-PANEL 63-74" L 13653008"
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$92.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$197.18
|
| Rate for Payer: The Alliance Commercial |
$151.13
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
BINDER ABDOMINAL 12 4-PANEL 63-74" L 13653008"
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
BINDER ABDOMINAL 12 4-PANEL 75-84" XL 13654009"
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
BINDER ABDOMINAL 12 4-PANEL 75-84" XL 13654009"
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$151.13
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
BINDER ABDOMINAL 12 4-PANEL 85-94"X XL 13655010"
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
BINDER ABDOMINAL 12 4-PANEL 85-94"X XL 13655010"
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.38
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$169.10
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$169.10
|
| Rate for Payer: The Alliance Commercial |
$151.13
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
Binocular Microscopy
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
2566799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$167.96 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$7.69
|
| Rate for Payer: Anthem Medicare Advantage |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.69
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$167.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.69
|
| Rate for Payer: Health EOS Commercial |
$160.89
|
| Rate for Payer: HFN Commercial |
$167.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$11.53
|
| Rate for Payer: Preferred Network Access Commercial |
$167.96
|
| Rate for Payer: Quartz Beloit One Network |
$77.79
|
| Rate for Payer: Quartz Commercial |
$100.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7.69
|
| Rate for Payer: The Alliance Commercial |
$19.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.69
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$30.74
|
|
|
BIO A TISSUE REINFO 7cm X 10cm
|
Facility
|
IP
|
$5,796.00
|
|
| Hospital Charge Code |
2967378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,953.64 |
| Max. Negotiated Rate |
$5,545.61 |
| Rate for Payer: Aetna Commercial |
$5,425.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.76
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,545.61
|
| Rate for Payer: Health EOS Commercial |
$5,364.78
|
| Rate for Payer: HFN Commercial |
$5,545.61
|
| Rate for Payer: Multiplan Commercial |
$4,822.27
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.64
|
| Rate for Payer: Quartz Commercial |
$3,616.70
|
| Rate for Payer: WEA Trust Commercial |
$3,315.31
|
| Rate for Payer: WPS Commercial |
$4,464.66
|
|
|
BIO A TISSUE REINFO 7cm X 10cm
|
Facility
|
OP
|
$5,796.00
|
|
| Hospital Charge Code |
2967378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.80 |
| Max. Negotiated Rate |
$5,545.61 |
| Rate for Payer: Aetna Commercial |
$5,425.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,687.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,918.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,013.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,893.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.76
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,545.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,373.27
|
| Rate for Payer: Health EOS Commercial |
$5,364.78
|
| Rate for Payer: HFN Commercial |
$5,545.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,520.88
|
| Rate for Payer: Multiplan Commercial |
$4,822.27
|
| Rate for Payer: NAPHCARE Commercial |
$3,616.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.64
|
| Rate for Payer: Quartz Commercial |
$3,918.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,616.70
|
| Rate for Payer: The Alliance Commercial |
$3,013.92
|
| Rate for Payer: WEA Trust Commercial |
$3,315.31
|
| Rate for Payer: WPS Commercial |
$4,464.66
|
|
|
BIOFDBK TRNG PERI/URO/RECT w/EMG and/or MANOMTRY 15 MIN 90912
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
5561223
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$37.45
|
| Rate for Payer: Anthem Medicare Advantage |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.45
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.45
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.45
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$56.18
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$37.45
|
| Rate for Payer: The Alliance Commercial |
$93.63
|
| Rate for Payer: United Healthcare Medicaid |
$64.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.45
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$149.80
|
|
|
BIOFDBK TRNG PERI/URO/RECT w/EMG and/or MANOMTY 15 MIN 90912
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
5561225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$37.45
|
| Rate for Payer: Anthem Medicare Advantage |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.45
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.45
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.45
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$56.18
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$37.45
|
| Rate for Payer: The Alliance Commercial |
$93.63
|
| Rate for Payer: United Healthcare Medicaid |
$64.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.45
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$149.80
|
|
|
Biofeedback Training: Perineal Muscles, Anorectal Or urethral Sphincter
|
Professional
|
Both
|
$311.00
|
|
| Hospital Charge Code |
1190815
|
| Min. Negotiated Rate |
$142.31 |
| Max. Negotiated Rate |
$307.27 |
| Rate for Payer: Aetna Commercial |
$307.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.16
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cigna Commercial |
$307.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.06
|
| Rate for Payer: Health EOS Commercial |
$294.33
|
| Rate for Payer: HFN Commercial |
$307.27
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: Preferred Network Access Commercial |
$307.27
|
| Rate for Payer: Quartz Beloit One Network |
$142.31
|
| Rate for Payer: Quartz Commercial |
$184.36
|
| Rate for Payer: The Alliance Commercial |
$161.72
|
| Rate for Payer: WEA Trust Commercial |
$177.89
|
| Rate for Payer: WPS Commercial |
$239.56
|
|
|
BIOFREEZE 360 SPRAY 4oz 081697374
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
2969697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$63.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.04
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$136.03
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$136.03
|
| Rate for Payer: The Alliance Commercial |
$113.36
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
BIOFREEZE 360 SPRAY 4oz 081697374
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
2969697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
BIOFREEZE 4oz TUBE
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2969696
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
BIOFREEZE 4oz TUBE
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2969696
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
BIOGLUE SYRINGE 5ML BG3515-5-US
|
Facility
|
IP
|
$5,940.00
|
|
|
Service Code
|
HCPCS A4364
|
| Hospital Charge Code |
2965000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,027.02 |
| Max. Negotiated Rate |
$5,683.39 |
| Rate for Payer: Aetna Commercial |
$5,559.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,312.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,274.13
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna Commercial |
$5,683.39
|
| Rate for Payer: Health EOS Commercial |
$5,498.06
|
| Rate for Payer: HFN Commercial |
$5,683.39
|
| Rate for Payer: Multiplan Commercial |
$4,942.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,683.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.02
|
| Rate for Payer: Quartz Commercial |
$3,706.56
|
| Rate for Payer: WEA Trust Commercial |
$3,397.68
|
| Rate for Payer: WPS Commercial |
$4,575.58
|
|
|
BIOGLUE SYRINGE 5ML BG3515-5-US
|
Facility
|
OP
|
$5,940.00
|
|
|
Service Code
|
HCPCS A4364
|
| Hospital Charge Code |
2965000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$5,683.39 |
| Rate for Payer: Aetna Commercial |
$5,559.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,312.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,729.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,015.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,088.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,965.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,274.13
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna Commercial |
$5,683.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,457.08
|
| Rate for Payer: Health EOS Commercial |
$5,498.06
|
| Rate for Payer: HFN Commercial |
$5,683.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,633.20
|
| Rate for Payer: Multiplan Commercial |
$4,942.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,706.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,683.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.02
|
| Rate for Payer: Quartz Commercial |
$4,015.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,706.56
|
| Rate for Payer: The Alliance Commercial |
$14.81
|
| Rate for Payer: WEA Trust Commercial |
$3,397.68
|
| Rate for Payer: WPS Commercial |
$4,575.58
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$66,240.72
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$19,339.83 |
| Max. Negotiated Rate |
$66,240.72 |
| Rate for Payer: Aetna Managed Medicare |
$19,339.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,657.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,128.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,074.52
|
| Rate for Payer: Anthem Medicare Advantage |
$19,339.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,339.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,339.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,339.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,376.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,339.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,341.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,339.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,339.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,339.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,339.83
|
| Rate for Payer: NAPHCARE Commercial |
$29,009.74
|
| Rate for Payer: Quartz Medicare Advantage |
$19,339.83
|
| Rate for Payer: The Alliance Commercial |
$66,240.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,339.83
|
| Rate for Payer: United Healthcare PPO |
$37,634.43
|
| Rate for Payer: Wellcare Medicare |
$19,339.83
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$93,484.56
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$26,962.78 |
| Max. Negotiated Rate |
$93,484.56 |
| Rate for Payer: Aetna Managed Medicare |
$26,962.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,376.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57,775.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54,890.55
|
| Rate for Payer: Anthem Medicare Advantage |
$26,962.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,962.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,962.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,962.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60,933.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,962.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,323.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,962.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,962.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,962.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,962.78
|
| Rate for Payer: NAPHCARE Commercial |
$40,444.17
|
| Rate for Payer: Quartz Medicare Advantage |
$26,962.78
|
| Rate for Payer: The Alliance Commercial |
$93,484.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,962.78
|
| Rate for Payer: United Healthcare PPO |
$53,190.58
|
| Rate for Payer: Wellcare Medicare |
$26,962.78
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$51,872.08
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$14,742.60 |
| Max. Negotiated Rate |
$51,872.08 |
| Rate for Payer: Aetna Managed Medicare |
$14,742.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,559.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,088.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,536.29
|
| Rate for Payer: Anthem Medicare Advantage |
$14,742.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,742.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,742.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,742.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,787.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,742.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,801.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,742.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,742.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,742.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,742.60
|
| Rate for Payer: NAPHCARE Commercial |
$22,113.90
|
| Rate for Payer: Quartz Medicare Advantage |
$14,742.60
|
| Rate for Payer: The Alliance Commercial |
$51,872.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,742.60
|
| Rate for Payer: United Healthcare PPO |
$29,429.28
|
| Rate for Payer: Wellcare Medicare |
$14,742.60
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE 24065
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
CPT 24065
|
| Hospital Charge Code |
3013804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Aetna Commercial |
$529.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.40
|
| Rate for Payer: Aetna Managed Medicare |
$144.80
|
| Rate for Payer: Anthem Medicare Advantage |
$144.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$529.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.80
|
| Rate for Payer: Health EOS Commercial |
$507.27
|
| Rate for Payer: HFN Commercial |
$529.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.80
|
| Rate for Payer: Multiplan Commercial |
$445.95
|
| Rate for Payer: NAPHCARE Commercial |
$217.20
|
| Rate for Payer: Preferred Network Access Commercial |
$529.57
|
| Rate for Payer: Quartz Beloit One Network |
$245.27
|
| Rate for Payer: Quartz Commercial |
$317.74
|
| Rate for Payer: Quartz Medicare Advantage |
$144.80
|
| Rate for Payer: The Alliance Commercial |
$615.40
|
| Rate for Payer: United Healthcare Medicaid |
$81.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.80
|
| Rate for Payer: WEA Trust Commercial |
$306.59
|
| Rate for Payer: WPS Commercial |
$651.60
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE 24066
|
Professional
|
Both
|
$1,369.00
|
|
|
Service Code
|
CPT 24066
|
| Hospital Charge Code |
3013805
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.28 |
| Max. Negotiated Rate |
$1,776.76 |
| Rate for Payer: Aetna Commercial |
$1,352.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.43
|
| Rate for Payer: Aetna Managed Medicare |
$394.84
|
| Rate for Payer: Anthem Medicare Advantage |
$394.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.84
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,352.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.84
|
| Rate for Payer: Health EOS Commercial |
$1,295.62
|
| Rate for Payer: HFN Commercial |
$1,352.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,441.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,441.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.84
|
| Rate for Payer: Multiplan Commercial |
$1,139.01
|
| Rate for Payer: NAPHCARE Commercial |
$592.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,352.57
|
| Rate for Payer: Quartz Beloit One Network |
$626.45
|
| Rate for Payer: Quartz Commercial |
$811.54
|
| Rate for Payer: Quartz Medicare Advantage |
$394.84
|
| Rate for Payer: The Alliance Commercial |
$1,678.05
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.84
|
| Rate for Payer: WEA Trust Commercial |
$783.07
|
| Rate for Payer: WPS Commercial |
$1,776.76
|
|
|
BIOPSY, BLADDER
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959845
|
|
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
|
|
|
BIOPSY, BLADDER
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959845
|
|
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
|
|
