|
Coccidioides Antibody ID
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Coccidioides Antibody ID
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.00
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: HFN Commercial |
$71.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$71.25
|
| Rate for Payer: Quartz Beloit One Network |
$33.00
|
| Rate for Payer: Quartz Commercial |
$42.75
|
| Rate for Payer: The Alliance Commercial |
$37.50
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Coccidioides Antibody ID
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.04
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.88
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$56.25
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Coenzyme Q10 Level
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.25
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Coenzyme Q10 Level
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.68 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$163.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.20
|
| Rate for Payer: Health EOS Commercial |
$156.52
|
| Rate for Payer: HFN Commercial |
$163.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Preferred Network Access Commercial |
$163.40
|
| Rate for Payer: Quartz Beloit One Network |
$75.68
|
| Rate for Payer: Quartz Commercial |
$98.04
|
| Rate for Payer: The Alliance Commercial |
$86.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Coenzyme Q10 Level
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
COIL MREYE CHROMIUM/IRON 5CM X 4MM X .035 3.9 LOOP G20322
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6201004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.28 |
| Max. Negotiated Rate |
$8,804.00 |
| Rate for Payer: Aetna Commercial |
$1,980.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.86
|
| Rate for Payer: Aetna Managed Medicare |
$616.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,430.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,100.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.53
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Cigna Commercial |
$2,024.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,231.68
|
| Rate for Payer: Health EOS Commercial |
$1,958.89
|
| Rate for Payer: HFN Commercial |
$2,024.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,650.75
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,320.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.49
|
| Rate for Payer: Quartz Commercial |
$1,430.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,320.60
|
| Rate for Payer: The Alliance Commercial |
$8,804.00
|
| Rate for Payer: WEA Trust Commercial |
$1,210.55
|
| Rate for Payer: WPS Commercial |
$1,630.28
|
|
|
COIL MREYE CHROMIUM/IRON 5CM X 4MM X .035 3.9 LOOP G20322
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6201004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.49 |
| Max. Negotiated Rate |
$2,024.92 |
| Rate for Payer: Aetna Commercial |
$1,980.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.53
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Cigna Commercial |
$2,024.92
|
| Rate for Payer: Health EOS Commercial |
$1,958.89
|
| Rate for Payer: HFN Commercial |
$2,024.92
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,320.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.49
|
| Rate for Payer: Quartz Commercial |
$1,320.60
|
| Rate for Payer: WEA Trust Commercial |
$1,210.55
|
| Rate for Payer: WPS Commercial |
$1,630.28
|
|
|
COIL MREYE EMBOLIZATION 5CM X 5MM .035 3.1 LOOP G36405
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200994
|
|
Hospital Revenue Code
|
273
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
COIL MREYE EMBOLIZATION 5CM X 5MM .035 3.1 LOOP G36405
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200994
|
|
Hospital Revenue Code
|
273
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Aetna Managed Medicare |
$350.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$812.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$699.50
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$812.50
|
| Rate for Payer: Quartz Medicare Advantage |
$750.00
|
| Rate for Payer: The Alliance Commercial |
$5,000.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
COIL MREYE EMBOLIZATION 5CM X 6MM .035 2.6 LOOP G20291
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Aetna Managed Medicare |
$350.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$812.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$699.50
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$812.50
|
| Rate for Payer: Quartz Medicare Advantage |
$750.00
|
| Rate for Payer: The Alliance Commercial |
$5,000.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
COIL MREYE EMBOLIZATION 5CM X 6MM .035 2.6 LOOP G20291
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
COIL NESTER 14-10 #G26991
|
Facility
|
OP
|
$1,791.00
|
|
| Hospital Charge Code |
2972455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.48 |
| Max. Negotiated Rate |
$7,164.00 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Aetna Managed Medicare |
$501.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$859.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.24
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.25
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,164.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,074.60
|
| Rate for Payer: The Alliance Commercial |
$7,164.00
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
COIL NESTER 14-10 #G26991
|
Facility
|
IP
|
$1,791.00
|
|
| Hospital Charge Code |
2972455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$877.59 |
| Max. Negotiated Rate |
$1,647.72 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,074.60
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
COIL NESTER 14-12mm #G26992
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| 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
|
|
|
COIL NESTER 14-12mm #G26992
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972432
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
COIL NESTER 4mm
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| 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
|
|
|
COIL NESTER 4mm
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972429
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
COIL NESTER 6mm
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972430
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
COIL NESTER 6mm
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| 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
|
|
|
COIL NESTER 8mm
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972431
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
COIL NESTER 8mm
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| 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
|
|
|
COIL TORNADO 35 10/5 #G10413
|
Facility
|
OP
|
$1,554.00
|
|
| Hospital Charge Code |
2972544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.12 |
| Max. Negotiated Rate |
$6,216.00 |
| Rate for Payer: Aetna Commercial |
$1,398.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.44
|
| Rate for Payer: Aetna Managed Medicare |
$435.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,010.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$777.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.62
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,429.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.62
|
| Rate for Payer: Health EOS Commercial |
$1,383.06
|
| Rate for Payer: HFN Commercial |
$1,429.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.50
|
| Rate for Payer: Multiplan Commercial |
$1,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$932.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.68
|
| Rate for Payer: Quartz Beloit One Network |
$761.46
|
| Rate for Payer: Quartz Commercial |
$1,010.10
|
| Rate for Payer: Quartz Medicare Advantage |
$932.40
|
| Rate for Payer: The Alliance Commercial |
$6,216.00
|
| Rate for Payer: WEA Trust Commercial |
$854.70
|
| Rate for Payer: WPS Commercial |
$1,151.05
|
|
|
COIL TORNADO 35 10/5 #G10413
|
Facility
|
IP
|
$1,554.00
|
|
| Hospital Charge Code |
2972544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.46 |
| Max. Negotiated Rate |
$1,429.68 |
| Rate for Payer: Aetna Commercial |
$1,398.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.62
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,429.68
|
| Rate for Payer: Health EOS Commercial |
$1,383.06
|
| Rate for Payer: HFN Commercial |
$1,429.68
|
| Rate for Payer: Multiplan Commercial |
$1,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$932.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.68
|
| Rate for Payer: Quartz Beloit One Network |
$761.46
|
| Rate for Payer: Quartz Commercial |
$932.40
|
| Rate for Payer: WEA Trust Commercial |
$854.70
|
| Rate for Payer: WPS Commercial |
$1,151.05
|
|
|
COIL TORNADO 35-8/5 (G10412)
|
Facility
|
IP
|
$1,554.00
|
|
| Hospital Charge Code |
2972545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.46 |
| Max. Negotiated Rate |
$1,429.68 |
| Rate for Payer: Aetna Commercial |
$1,398.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.62
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,429.68
|
| Rate for Payer: Health EOS Commercial |
$1,383.06
|
| Rate for Payer: HFN Commercial |
$1,429.68
|
| Rate for Payer: Multiplan Commercial |
$1,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$932.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.68
|
| Rate for Payer: Quartz Beloit One Network |
$761.46
|
| Rate for Payer: Quartz Commercial |
$932.40
|
| Rate for Payer: WEA Trust Commercial |
$854.70
|
| Rate for Payer: WPS Commercial |
$1,151.05
|
|
