|
BLADE STERNUM REVISION SAGITTAL SAFEDGE 2108-125-000
|
Facility
|
OP
|
$843.00
|
|
| Hospital Charge Code |
4519117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$806.58 |
| Rate for Payer: Aetna Commercial |
$789.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Aetna Managed Medicare |
$245.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.66
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$806.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.63
|
| Rate for Payer: Health EOS Commercial |
$780.28
|
| Rate for Payer: HFN Commercial |
$806.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.54
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: NAPHCARE Commercial |
$526.03
|
| Rate for Payer: Preferred Network Access Commercial |
$806.58
|
| Rate for Payer: Quartz Beloit One Network |
$429.59
|
| Rate for Payer: Quartz Commercial |
$569.87
|
| Rate for Payer: Quartz Medicare Advantage |
$526.03
|
| Rate for Payer: The Alliance Commercial |
$438.36
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$649.36
|
|
|
BLADE STERNUM SAW 5059-532
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
2965526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.05
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.34
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$95.47
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$103.43
|
| Rate for Payer: Quartz Medicare Advantage |
$95.47
|
| Rate for Payer: The Alliance Commercial |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
BLADE STERNUM SAW 5059-532
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
2965526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
BLADE STERNUM SAW STRYKER 298-97-100
|
Facility
|
OP
|
$541.00
|
|
| Hospital Charge Code |
4518781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.54 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Aetna Managed Medicare |
$157.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.86
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.98
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$337.58
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$365.72
|
| Rate for Payer: Quartz Medicare Advantage |
$337.58
|
| Rate for Payer: The Alliance Commercial |
$281.32
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
BLADE STERNUM SAW STRYKER 298-97-100
|
Facility
|
IP
|
$541.00
|
|
| Hospital Charge Code |
4518781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.69 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$337.58
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
BLADE TENDON STRIPPER 10MM AR-2385-10
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5563609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
BLADE TENDON STRIPPER 10MM AR-2385-10
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5563609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.50 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE 73-1191
|
Facility
|
IP
|
$3,140.00
|
|
| Hospital Charge Code |
5349393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,600.14 |
| Max. Negotiated Rate |
$3,004.35 |
| Rate for Payer: Aetna Commercial |
$2,939.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,808.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.77
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$3,004.35
|
| Rate for Payer: Health EOS Commercial |
$2,906.38
|
| Rate for Payer: HFN Commercial |
$3,004.35
|
| Rate for Payer: Multiplan Commercial |
$2,612.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,004.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,600.14
|
| Rate for Payer: Quartz Commercial |
$1,959.36
|
| Rate for Payer: WEA Trust Commercial |
$1,796.08
|
| Rate for Payer: WPS Commercial |
$2,418.74
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE 73-1191
|
Facility
|
OP
|
$3,140.00
|
|
| Hospital Charge Code |
5349393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.37 |
| Max. Negotiated Rate |
$3,004.35 |
| Rate for Payer: Aetna Commercial |
$2,939.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,808.42
|
| Rate for Payer: Aetna Managed Medicare |
$914.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,122.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,567.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.77
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$3,004.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,827.48
|
| Rate for Payer: Health EOS Commercial |
$2,906.38
|
| Rate for Payer: HFN Commercial |
$3,004.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,449.20
|
| Rate for Payer: Multiplan Commercial |
$2,612.48
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,004.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,600.14
|
| Rate for Payer: Quartz Commercial |
$2,122.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,959.36
|
| Rate for Payer: The Alliance Commercial |
$1,632.80
|
| Rate for Payer: WEA Trust Commercial |
$1,796.08
|
| Rate for Payer: WPS Commercial |
$2,418.74
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE STANDARD 73-1194
|
Facility
|
IP
|
$1,664.00
|
|
| Hospital Charge Code |
5659737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.97 |
| Max. Negotiated Rate |
$1,592.12 |
| Rate for Payer: Aetna Commercial |
$1,557.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,592.12
|
| Rate for Payer: Health EOS Commercial |
$1,540.20
|
| Rate for Payer: HFN Commercial |
$1,592.12
|
| Rate for Payer: Multiplan Commercial |
$1,384.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.12
|
| Rate for Payer: Quartz Beloit One Network |
$847.97
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: WEA Trust Commercial |
$951.81
|
| Rate for Payer: WPS Commercial |
$1,281.78
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE STANDARD 73-1194
|
Facility
|
OP
|
$1,664.00
|
|
| Hospital Charge Code |
5659737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.56 |
| Max. Negotiated Rate |
$1,592.12 |
| Rate for Payer: Aetna Commercial |
$1,557.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.28
|
| Rate for Payer: Aetna Managed Medicare |
$484.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,124.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$865.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$830.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,592.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$968.45
|
| Rate for Payer: Health EOS Commercial |
$1,540.20
|
| Rate for Payer: HFN Commercial |
$1,592.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,297.92
|
| Rate for Payer: Multiplan Commercial |
$1,384.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.12
|
| Rate for Payer: Quartz Beloit One Network |
$847.97
|
| Rate for Payer: Quartz Commercial |
$1,124.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,038.34
|
| Rate for Payer: The Alliance Commercial |
$865.28
|
| Rate for Payer: WEA Trust Commercial |
$951.81
|
| Rate for Payer: WPS Commercial |
$1,281.78
|
|
|
BLAKE DRAIN SILICONE 15FR ROUND HUBLESS 3/16 IN TROCAR 2229
|
Facility
|
IP
|
$2,081.95
|
|
| Hospital Charge Code |
6246183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.96 |
| Max. Negotiated Rate |
$1,992.01 |
| Rate for Payer: Aetna Commercial |
$1,948.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,862.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.57
|
| Rate for Payer: Cash Price |
$624.58
|
| Rate for Payer: Cigna Commercial |
$1,992.01
|
| Rate for Payer: Health EOS Commercial |
$1,927.05
|
| Rate for Payer: HFN Commercial |
$1,992.01
|
| Rate for Payer: Multiplan Commercial |
$1,732.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,992.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.96
|
| Rate for Payer: Quartz Commercial |
$1,299.14
|
| Rate for Payer: WEA Trust Commercial |
$1,190.88
|
| Rate for Payer: WPS Commercial |
$1,603.73
|
|
|
BLAKE DRAIN SILICONE 15FR ROUND HUBLESS 3/16 IN TROCAR 2229
|
Facility
|
OP
|
$2,081.95
|
|
| Hospital Charge Code |
6246183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.26 |
| Max. Negotiated Rate |
$1,992.01 |
| Rate for Payer: Aetna Commercial |
$1,948.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,862.10
|
| Rate for Payer: Aetna Managed Medicare |
$606.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,407.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,082.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,039.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.57
|
| Rate for Payer: Cash Price |
$624.58
|
| Rate for Payer: Cigna Commercial |
$1,992.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,211.69
|
| Rate for Payer: Health EOS Commercial |
$1,927.05
|
| Rate for Payer: HFN Commercial |
$1,992.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,623.92
|
| Rate for Payer: Multiplan Commercial |
$1,732.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,299.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,992.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.96
|
| Rate for Payer: Quartz Commercial |
$1,407.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,299.14
|
| Rate for Payer: The Alliance Commercial |
$1,082.61
|
| Rate for Payer: WEA Trust Commercial |
$1,190.88
|
| Rate for Payer: WPS Commercial |
$1,603.73
|
|
|
Blanket, Bair Hugger
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
3101756
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Blanket, Bair Hugger
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
3101756
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
BLANKET FULL BODY AIR WARMING #40034
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2964000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
BLANKET FULL BODY AIR WARMING #40034
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2964000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
BLANKET LOWER BODY AIR WARMING BAIR HUGGER #42534
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
2972071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$47.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$101.71
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$101.71
|
| Rate for Payer: The Alliance Commercial |
$84.76
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
BLANKET LOWER BODY AIR WARMING BAIR HUGGER #42534
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
2972071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
BLANKET UNDERBODY FULL ACCESS #63500
|
Facility
|
OP
|
$634.00
|
|
| Hospital Charge Code |
2965811
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.99
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.52
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$395.62
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$428.58
|
| Rate for Payer: Quartz Medicare Advantage |
$395.62
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
BLANKET UNDERBODY FULL ACCESS #63500
|
Facility
|
IP
|
$634.00
|
|
| Hospital Charge Code |
2965811
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$323.09 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$395.62
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
BLANKET UPPER BODY AIR WARMING #42234
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
2969960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.71 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$52.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.34
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$112.94
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$112.94
|
| Rate for Payer: The Alliance Commercial |
$94.12
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
BLANKET UPPER BODY AIR WARMING #42234
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
2969960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$92.24 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$112.94
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
Blastomyces Antibody
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5598645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Blastomyces Antibody
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5598645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$59.03 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
