|
BURR CORTICAL SPHERE 4MM 58RSPH40
|
Facility
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6199057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR CORTICAL SPHERE 4MM 58RSPH40
|
Facility
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6199057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BUR ROUND BUTT 4.0MM AR-8400RBE
|
Facility
OP
|
$959.00
|
|
| Hospital Charge Code |
5206678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR ROUND BUTT 4.0MM AR-8400RBE
|
Facility
IP
|
$959.00
|
|
| Hospital Charge Code |
5206678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR ROUND DIAMOND 1.5 X 48 CRS E5215
|
Facility
IP
|
$1,464.00
|
|
| Hospital Charge Code |
2964869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
BUR ROUND DIAMOND 1.5 X 48 CRS E5215
|
Facility
OP
|
$1,464.00
|
|
| Hospital Charge Code |
2964869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
BUR ROUND DIAMOND 4 X 48 #E6240
|
Facility
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.64 |
| Max. Negotiated Rate |
$6,952.00 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| Rate for Payer: Aetna Managed Medicare |
$486.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,129.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$869.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$834.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$972.58
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,303.50
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,129.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,042.80
|
| Rate for Payer: The Alliance Commercial |
$6,952.00
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
|
BUR ROUND DIAMOND 4 X 48 #E6240
|
Facility
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,042.80
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
|
BURR SCULPTING 2 X 8MM CYLINDER 58SC2008
|
Facility
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6182014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 2 X 8MM CYLINDER 58SC2008
|
Facility
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6182014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 3 X 12MM CYLINDER 58SC3012
|
Facility
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6199058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 3 X 12MM CYLINDER 58SC3012
|
Facility
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6199058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 4 X 16MM CYLINDER 58SC4016
|
Facility
OP
|
$5,625.00
|
|
| Hospital Charge Code |
6179880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,575.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,656.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,812.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.75
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,218.75
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,656.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,375.00
|
| Rate for Payer: The Alliance Commercial |
$22,500.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
BURR SCULPTING 4 X 16MM CYLINDER 58SC4016
|
Facility
IP
|
$5,625.00
|
|
| Hospital Charge Code |
6179880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,756.25 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
Buspirone Level
|
Facility
OP
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$384.80 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.73
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$85.62
|
| Rate for Payer: HFN Commercial |
$88.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$76.96
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$88.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$47.14
|
| Rate for Payer: Quartz Commercial |
$62.53
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$384.80
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$72.15
|
| Rate for Payer: WEA Trust Commercial |
$52.91
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$71.26
|
|
|
Buspirone Level
|
Facility
IP
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.99
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Health EOS Commercial |
$85.62
|
| Rate for Payer: HFN Commercial |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$76.96
|
| Rate for Payer: NAPHCARE Commercial |
$57.72
|
| Rate for Payer: Preferred Network Access Commercial |
$88.50
|
| Rate for Payer: Quartz Beloit One Network |
$47.14
|
| Rate for Payer: Quartz Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$52.91
|
| Rate for Payer: WPS Commercial |
$71.26
|
|
|
Buspirone Level
|
Professional
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Aetna Commercial |
$91.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.73
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$91.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$87.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$76.96
|
| Rate for Payer: Preferred Network Access Commercial |
$91.39
|
| Rate for Payer: Quartz Beloit One Network |
$42.33
|
| Rate for Payer: Quartz Commercial |
$54.83
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$52.91
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Butalbital, Urine
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Butalbital, Urine
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$65.40
|
| Rate for Payer: United Healthcare PPO |
$81.75
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Butalbital, Urine
|
Professional
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.40
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: The Alliance Commercial |
$54.50
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
BUTTON NASAL SEPTAL 2-PART SILICONE 1524110
|
Facility
OP
|
$2,777.00
|
|
| Hospital Charge Code |
2965318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.56 |
| Max. Negotiated Rate |
$11,108.00 |
| Rate for Payer: Aetna Commercial |
$2,499.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.22
|
| Rate for Payer: Aetna Managed Medicare |
$777.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,805.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,388.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.81
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,554.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,554.01
|
| Rate for Payer: Health EOS Commercial |
$2,471.53
|
| Rate for Payer: HFN Commercial |
$2,554.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,082.75
|
| Rate for Payer: Multiplan Commercial |
$2,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.73
|
| Rate for Payer: Quartz Commercial |
$1,805.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,666.20
|
| Rate for Payer: The Alliance Commercial |
$11,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,527.35
|
| Rate for Payer: WPS Commercial |
$2,056.92
|
|
|
BUTTON NASAL SEPTAL 2-PART SILICONE 1524110
|
Facility
IP
|
$2,777.00
|
|
| Hospital Charge Code |
2965318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,360.73 |
| Max. Negotiated Rate |
$2,554.84 |
| Rate for Payer: Aetna Commercial |
$2,499.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.81
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,554.84
|
| Rate for Payer: Health EOS Commercial |
$2,471.53
|
| Rate for Payer: HFN Commercial |
$2,554.84
|
| Rate for Payer: Multiplan Commercial |
$2,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.73
|
| Rate for Payer: Quartz Commercial |
$1,666.20
|
| Rate for Payer: WEA Trust Commercial |
$1,527.35
|
| Rate for Payer: WPS Commercial |
$2,056.92
|
|
|
BUTTON NASAL SEPTAL 3CM SILICONE SINGLE UNIT 1524105
|
Facility
OP
|
$2,380.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.40 |
| Max. Negotiated Rate |
$2,189.60 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.80
|
| Rate for Payer: Aetna Managed Medicare |
$666.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.40
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.85
|
| Rate for Payer: Health EOS Commercial |
$2,118.20
|
| Rate for Payer: HFN Commercial |
$2,189.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.00
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.20
|
| Rate for Payer: Quartz Commercial |
$1,547.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,309.00
|
| Rate for Payer: WPS Commercial |
$1,762.87
|
|
|
BUTTON NASAL SEPTAL 3CM SILICONE SINGLE UNIT 1524105
|
Facility
IP
|
$2,380.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,166.20 |
| Max. Negotiated Rate |
$2,189.60 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.40
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: Health EOS Commercial |
$2,118.20
|
| Rate for Payer: HFN Commercial |
$2,189.60
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.20
|
| Rate for Payer: Quartz Commercial |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,309.00
|
| Rate for Payer: WPS Commercial |
$1,762.87
|
|
|
BUTTON OLYMPUS BIPOLAR HF 12/30 DEG WA22760S/WA22557C
|
Facility
IP
|
$5,794.00
|
|
| Hospital Charge Code |
4510815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,839.06 |
| Max. Negotiated Rate |
$5,330.48 |
| Rate for Payer: Aetna Commercial |
$5,214.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,070.82
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Cigna Commercial |
$5,330.48
|
| Rate for Payer: Health EOS Commercial |
$5,156.66
|
| Rate for Payer: HFN Commercial |
$5,330.48
|
| Rate for Payer: Multiplan Commercial |
$4,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,476.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,330.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.06
|
| Rate for Payer: Quartz Commercial |
$3,476.40
|
| Rate for Payer: WEA Trust Commercial |
$3,186.70
|
| Rate for Payer: WPS Commercial |
$4,291.62
|
|
