|
BIOPSY, VULVAR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959899
|
|
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, VULVAR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959899
|
|
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
|
|
|
BIO SCREW 9X28
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
BIO SCREW 9X28
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
Biotinidase
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
4524639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$185.74 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$185.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$177.92
|
| Rate for Payer: HFN Commercial |
$185.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$26.32
|
| Rate for Payer: Preferred Network Access Commercial |
$185.74
|
| Rate for Payer: Quartz Beloit One Network |
$86.03
|
| Rate for Payer: Quartz Commercial |
$111.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$69.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$77.20
|
|
|
Biotinidase
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
4524639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
Biotinidase
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
4524639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.12
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$26.32
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$70.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: United Healthcare PPO |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: Wellcare Medicare |
$17.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
BIO-TRANSFIX BONE TENDON BONE
|
Facility
|
IP
|
$5,039.00
|
|
| Hospital Charge Code |
2964676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,567.87 |
| Max. Negotiated Rate |
$4,821.32 |
| Rate for Payer: Aetna Commercial |
$4,716.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,506.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.50
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,821.32
|
| Rate for Payer: Health EOS Commercial |
$4,664.10
|
| Rate for Payer: HFN Commercial |
$4,821.32
|
| Rate for Payer: Multiplan Commercial |
$4,192.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,567.87
|
| Rate for Payer: Quartz Commercial |
$3,144.34
|
| Rate for Payer: WEA Trust Commercial |
$2,882.31
|
| Rate for Payer: WPS Commercial |
$3,881.54
|
|
|
BIO-TRANSFIX BONE TENDON BONE
|
Facility
|
OP
|
$5,039.00
|
|
| Hospital Charge Code |
2964676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,467.36 |
| Max. Negotiated Rate |
$4,821.32 |
| Rate for Payer: Aetna Commercial |
$4,716.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,506.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,467.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,406.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,620.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,515.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.50
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,821.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,932.70
|
| Rate for Payer: Health EOS Commercial |
$4,664.10
|
| Rate for Payer: HFN Commercial |
$4,821.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,930.42
|
| Rate for Payer: Multiplan Commercial |
$4,192.45
|
| Rate for Payer: NAPHCARE Commercial |
$3,144.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,567.87
|
| Rate for Payer: Quartz Commercial |
$3,406.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,144.34
|
| Rate for Payer: The Alliance Commercial |
$2,620.28
|
| Rate for Payer: WEA Trust Commercial |
$2,882.31
|
| Rate for Payer: WPS Commercial |
$3,881.54
|
|
|
BIOZORB MARKER 2CM X 2CM F0202
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,819.62 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,452.59
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
BIOZORB MARKER 2CM X 2CM F0202
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.64 |
| Max. Negotiated Rate |
$5,826.58 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,740.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,877.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,762.07
|
| Rate for Payer: Anthem Medicare Advantage |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,456.64
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,456.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,418.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,456.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,456.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,456.64
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.97
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,740.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,456.64
|
| Rate for Payer: The Alliance Commercial |
$5,826.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,456.64
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: Wellcare Medicare |
$1,456.64
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
BIOZORB MARKER 2CM X 3CM F0203
|
Facility
|
IP
|
$5,744.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,927.14 |
| Max. Negotiated Rate |
$5,495.86 |
| Rate for Payer: Aetna Commercial |
$5,376.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,137.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,166.09
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cigna Commercial |
$5,495.86
|
| Rate for Payer: Health EOS Commercial |
$5,316.65
|
| Rate for Payer: HFN Commercial |
$5,495.86
|
| Rate for Payer: Multiplan Commercial |
$4,779.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,495.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.14
|
| Rate for Payer: Quartz Commercial |
$3,584.26
|
| Rate for Payer: WEA Trust Commercial |
$3,285.57
|
| Rate for Payer: WPS Commercial |
$4,424.60
|
|
|
BIOZORB MARKER 2CM X 3CM F0203
|
Facility
|
OP
|
$5,744.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.64 |
| Max. Negotiated Rate |
$5,826.58 |
| Rate for Payer: Aetna Commercial |
$5,376.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,137.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,882.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,986.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,867.40
|
| Rate for Payer: Anthem Medicare Advantage |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,166.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,456.64
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cigna Commercial |
$5,495.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,456.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,343.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$5,316.65
|
| Rate for Payer: HFN Commercial |
$5,495.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,418.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,456.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,456.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,456.64
|
| Rate for Payer: Multiplan Commercial |
$4,779.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.97
|
| Rate for Payer: Preferred Network Access Commercial |
$5,495.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.14
|
| Rate for Payer: Quartz Commercial |
$3,882.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,456.64
|
| Rate for Payer: The Alliance Commercial |
$5,826.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,456.64
|
| Rate for Payer: WEA Trust Commercial |
$3,285.57
|
| Rate for Payer: Wellcare Medicare |
$1,456.64
|
| Rate for Payer: WPS Commercial |
$4,424.60
|
|
|
BIOZORB MARKER 3CM X 3CM F0303
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.64 |
| Max. Negotiated Rate |
$5,826.58 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,740.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,877.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,762.07
|
| Rate for Payer: Anthem Medicare Advantage |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,456.64
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,456.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,418.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,456.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,456.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,456.64
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.97
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,740.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,456.64
|
| Rate for Payer: The Alliance Commercial |
$5,826.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,456.64
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: Wellcare Medicare |
$1,456.64
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
BIOZORB MARKER 3CM X 3CM F0303
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,819.62 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,452.59
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
BIOZORB MARKER 3CM X 4CM F0304
|
Facility
|
IP
|
$5,744.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5456768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,927.14 |
| Max. Negotiated Rate |
$5,495.86 |
| Rate for Payer: Aetna Commercial |
$5,376.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,137.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,166.09
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cigna Commercial |
$5,495.86
|
| Rate for Payer: Health EOS Commercial |
$5,316.65
|
| Rate for Payer: HFN Commercial |
$5,495.86
|
| Rate for Payer: Multiplan Commercial |
$4,779.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,495.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.14
|
| Rate for Payer: Quartz Commercial |
$3,584.26
|
| Rate for Payer: WEA Trust Commercial |
$3,285.57
|
| Rate for Payer: WPS Commercial |
$4,424.60
|
|
|
BIOZORB MARKER 3CM X 4CM F0304
|
Facility
|
OP
|
$5,744.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
5456768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.65 |
| Max. Negotiated Rate |
$5,495.86 |
| Rate for Payer: Aetna Commercial |
$5,376.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,137.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,672.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,882.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,986.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,867.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,166.09
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cigna Commercial |
$5,495.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,343.01
|
| Rate for Payer: Health EOS Commercial |
$5,316.65
|
| Rate for Payer: HFN Commercial |
$5,495.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,480.32
|
| Rate for Payer: Multiplan Commercial |
$4,779.01
|
| Rate for Payer: NAPHCARE Commercial |
$3,584.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,495.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.14
|
| Rate for Payer: Quartz Commercial |
$3,882.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,584.26
|
| Rate for Payer: The Alliance Commercial |
$2,986.88
|
| Rate for Payer: WEA Trust Commercial |
$3,285.57
|
| Rate for Payer: WPS Commercial |
$4,424.60
|
|
|
BIOZORB MARKER 4CM X 4CM F0404
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.64 |
| Max. Negotiated Rate |
$5,826.58 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,740.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,877.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,762.07
|
| Rate for Payer: Anthem Medicare Advantage |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,456.64
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,456.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,418.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,456.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,456.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,456.64
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.97
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,740.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,456.64
|
| Rate for Payer: The Alliance Commercial |
$5,826.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,456.64
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: Wellcare Medicare |
$1,456.64
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
BIOZORB MARKER 4CM X 4CM F0404
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
HCPCS C9728
|
| Hospital Charge Code |
5456769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,819.62 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,452.59
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
BIPOLAR COMPONENT UHR 51MM 28MM UHR-51-28
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3072570
|
|
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
|
|
|
BIPOLAR COMPONENT UHR 51MM 28MM UHR-51-28
|
Facility
|
OP
|
$5,796.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3072570
|
|
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
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$4,997.94
|
|
|
Service Code
|
APR-DRG 7532
|
| Min. Negotiated Rate |
$4,439.48 |
| Max. Negotiated Rate |
$4,997.94 |
| Rate for Payer: Anthem Medicaid |
$4,785.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,785.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,785.80
|
| Rate for Payer: Dean Health Medicaid |
$4,785.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,439.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4,997.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,785.80
|
| Rate for Payer: United Healthcare Medicaid |
$4,785.80
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$15,870.64
|
|
|
Service Code
|
APR-DRG 7534
|
| Min. Negotiated Rate |
$14,097.29 |
| Max. Negotiated Rate |
$15,870.64 |
| Rate for Payer: Anthem Medicaid |
$15,197.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,197.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,197.01
|
| Rate for Payer: Dean Health Medicaid |
$15,197.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,097.29
|
| Rate for Payer: Managed Health Services Medicaid |
$15,870.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,197.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,197.01
|
| Rate for Payer: United Healthcare Medicaid |
$15,197.01
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 7533
|
| Min. Negotiated Rate |
$8,100.10 |
| Max. Negotiated Rate |
$9,119.04 |
| Rate for Payer: Anthem Medicaid |
$8,731.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,731.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,731.99
|
| Rate for Payer: Dean Health Medicaid |
$8,731.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,100.10
|
| Rate for Payer: Managed Health Services Medicaid |
$9,119.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,731.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,731.99
|
| Rate for Payer: United Healthcare Medicaid |
$8,731.99
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$3,770.37
|
|
|
Service Code
|
APR-DRG 7531
|
| Min. Negotiated Rate |
$3,349.08 |
| Max. Negotiated Rate |
$3,770.37 |
| Rate for Payer: Anthem Medicaid |
$3,610.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,610.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,610.34
|
| Rate for Payer: Dean Health Medicaid |
$3,610.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,349.08
|
| Rate for Payer: Managed Health Services Medicaid |
$3,770.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,610.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,610.34
|
| Rate for Payer: United Healthcare Medicaid |
$3,610.34
|
|
