|
BURR CARTILAGE 2MM X 8MM CYLINDER SS 58CC2008
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
6180079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,638.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,802.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,273.75
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,387.50
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,802.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,510.00
|
| Rate for Payer: The Alliance Commercial |
$2,925.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
BURR CORTICAL SPHERE 4MM 58RSPH40
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6199057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,915.08 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,344.99
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
BURR CORTICAL SPHERE 4MM 58RSPH40
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6199057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.33 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,094.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,540.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,954.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,875.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,187.16
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,931.24
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,344.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,540.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,344.99
|
| Rate for Payer: The Alliance Commercial |
$1,954.16
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
BUR ROUND BUTT 4.0MM AR-8400RBE
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5206678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
BUR ROUND BUTT 4.0MM AR-8400RBE
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5206678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
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 |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
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 |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
BUR ROUND DIAMOND 4 X 48 #E6240
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
BUR ROUND DIAMOND 4 X 48 #E6240
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
BURR SCULPTING 2 X 8MM CYLINDER 58SC2008
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6182014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,915.08 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,344.99
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
BURR SCULPTING 2 X 8MM CYLINDER 58SC2008
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6182014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.33 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,094.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,540.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,954.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,875.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,187.16
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,931.24
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,344.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,540.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,344.99
|
| Rate for Payer: The Alliance Commercial |
$1,954.16
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
BURR SCULPTING 3 X 12MM CYLINDER 58SC3012
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6199058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.33 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,094.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,540.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,954.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,875.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,187.16
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,931.24
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,344.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,540.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,344.99
|
| Rate for Payer: The Alliance Commercial |
$1,954.16
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
BURR SCULPTING 3 X 12MM CYLINDER 58SC3012
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6199058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,915.08 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,344.99
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
BURR SCULPTING 4 X 16MM CYLINDER 58SC4016
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
6179880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,638.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,802.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,273.75
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,387.50
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,802.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,510.00
|
| Rate for Payer: The Alliance Commercial |
$2,925.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
BURR SCULPTING 4 X 16MM CYLINDER 58SC4016
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
6179880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,866.50 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,510.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
Buspirone Level
|
Facility
|
IP
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.02 |
| Max. Negotiated Rate |
$92.04 |
| Rate for Payer: Aetna Commercial |
$90.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.03
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$92.04
|
| Rate for Payer: Health EOS Commercial |
$89.04
|
| Rate for Payer: HFN Commercial |
$92.04
|
| Rate for Payer: Multiplan Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$92.04
|
| Rate for Payer: Quartz Beloit One Network |
$49.02
|
| Rate for Payer: Quartz Commercial |
$60.03
|
| Rate for Payer: WEA Trust Commercial |
$55.03
|
| Rate for Payer: WPS Commercial |
$74.10
|
|
|
Buspirone Level
|
Professional
|
Both
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$95.05 |
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.04
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$91.04
|
| Rate for Payer: HFN Commercial |
$95.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$80.04
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$95.05
|
| Rate for Payer: Quartz Beloit One Network |
$44.02
|
| Rate for Payer: Quartz Commercial |
$57.03
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$55.03
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Buspirone Level
|
Facility
|
OP
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$92.04 |
| Rate for Payer: Aetna Commercial |
$90.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.04
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$92.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$89.04
|
| Rate for Payer: HFN Commercial |
$92.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$80.04
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$92.04
|
| Rate for Payer: Quartz Beloit One Network |
$49.02
|
| Rate for Payer: Quartz Commercial |
$65.03
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$75.04
|
| Rate for Payer: WEA Trust Commercial |
$55.03
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$74.10
|
|
|
Butalbital, Urine
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$56.68
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Butalbital, Urine
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.02
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: The Alliance Commercial |
$56.68
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Butalbital, Urine
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
BUTTON NASAL SEPTAL 2-PART SILICONE 1524110
|
Facility
|
OP
|
$2,777.00
|
|
| Hospital Charge Code |
2965318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$808.66 |
| Max. Negotiated Rate |
$2,657.03 |
| Rate for Payer: Aetna Commercial |
$2,599.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,483.75
|
| Rate for Payer: Aetna Managed Medicare |
$808.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,877.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,444.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,386.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.68
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,657.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,616.21
|
| Rate for Payer: Health EOS Commercial |
$2,570.39
|
| Rate for Payer: HFN Commercial |
$2,657.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,166.06
|
| Rate for Payer: Multiplan Commercial |
$2,310.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,732.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,415.16
|
| Rate for Payer: Quartz Commercial |
$1,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,732.85
|
| Rate for Payer: The Alliance Commercial |
$1,444.04
|
| Rate for Payer: WEA Trust Commercial |
$1,588.44
|
| Rate for Payer: WPS Commercial |
$2,139.12
|
|
|
BUTTON NASAL SEPTAL 2-PART SILICONE 1524110
|
Facility
|
IP
|
$2,777.00
|
|
| Hospital Charge Code |
2965318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,415.16 |
| Max. Negotiated Rate |
$2,657.03 |
| Rate for Payer: Aetna Commercial |
$2,599.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,483.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.68
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,657.03
|
| Rate for Payer: Health EOS Commercial |
$2,570.39
|
| Rate for Payer: HFN Commercial |
$2,657.03
|
| Rate for Payer: Multiplan Commercial |
$2,310.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,415.16
|
| Rate for Payer: Quartz Commercial |
$1,732.85
|
| Rate for Payer: WEA Trust Commercial |
$1,588.44
|
| Rate for Payer: WPS Commercial |
$2,139.12
|
|
|
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 |
$693.06 |
| Max. Negotiated Rate |
$2,277.18 |
| Rate for Payer: Aetna Commercial |
$2,227.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.67
|
| Rate for Payer: Aetna Managed Medicare |
$693.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,608.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,237.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,188.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,311.86
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,277.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,385.16
|
| Rate for Payer: Health EOS Commercial |
$2,202.93
|
| Rate for Payer: HFN Commercial |
$2,277.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,856.40
|
| Rate for Payer: Multiplan Commercial |
$1,980.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,212.85
|
| Rate for Payer: Quartz Commercial |
$1,608.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,485.12
|
| Rate for Payer: The Alliance Commercial |
$1,237.60
|
| Rate for Payer: WEA Trust Commercial |
$1,361.36
|
| Rate for Payer: WPS Commercial |
$1,833.31
|
|
|
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 |
$1,212.85 |
| Max. Negotiated Rate |
$2,277.18 |
| Rate for Payer: Aetna Commercial |
$2,227.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,311.86
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,277.18
|
| Rate for Payer: Health EOS Commercial |
$2,202.93
|
| Rate for Payer: HFN Commercial |
$2,277.18
|
| Rate for Payer: Multiplan Commercial |
$1,980.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,212.85
|
| Rate for Payer: Quartz Commercial |
$1,485.12
|
| Rate for Payer: WEA Trust Commercial |
$1,361.36
|
| Rate for Payer: WPS Commercial |
$1,833.31
|
|
