|
DRIVER GRIDLOCK 317-24-003
|
Facility
IP
|
$2,585.00
|
|
| Hospital Charge Code |
5547441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
DRIVER HIGH TORQUE BIOMET 70-2001
|
Facility
IP
|
$2,055.00
|
|
| Hospital Charge Code |
5349383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.95 |
| Max. Negotiated Rate |
$1,890.60 |
| Rate for Payer: Aetna Commercial |
$1,849.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.15
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,890.60
|
| Rate for Payer: Health EOS Commercial |
$1,828.95
|
| Rate for Payer: HFN Commercial |
$1,890.60
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.95
|
| Rate for Payer: Quartz Commercial |
$1,233.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.25
|
| Rate for Payer: WPS Commercial |
$1,522.14
|
|
|
DRIVER HIGH TORQUE BIOMET 70-2001
|
Facility
OP
|
$2,055.00
|
|
| Hospital Charge Code |
5349383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.40 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Aetna Commercial |
$1,849.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,767.30
|
| Rate for Payer: Aetna Managed Medicare |
$575.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.15
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,890.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.98
|
| Rate for Payer: Health EOS Commercial |
$1,828.95
|
| Rate for Payer: HFN Commercial |
$1,890.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,541.25
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.95
|
| Rate for Payer: Quartz Commercial |
$1,335.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.00
|
| Rate for Payer: The Alliance Commercial |
$8,220.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.25
|
| Rate for Payer: WPS Commercial |
$1,522.14
|
|
|
DRIVER MSP T6 MS-DR
|
Facility
IP
|
$2,855.00
|
|
| Hospital Charge Code |
5510698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,398.95 |
| Max. Negotiated Rate |
$2,626.60 |
| Rate for Payer: Aetna Commercial |
$2,569.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,513.15
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$2,626.60
|
| Rate for Payer: Health EOS Commercial |
$2,540.95
|
| Rate for Payer: HFN Commercial |
$2,626.60
|
| Rate for Payer: Multiplan Commercial |
$2,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,713.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,626.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,398.95
|
| Rate for Payer: Quartz Commercial |
$1,713.00
|
| Rate for Payer: WEA Trust Commercial |
$1,570.25
|
| Rate for Payer: WPS Commercial |
$2,114.70
|
|
|
DRIVER MSP T6 MS-DR
|
Facility
OP
|
$2,855.00
|
|
| Hospital Charge Code |
5510698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.40 |
| Max. Negotiated Rate |
$11,420.00 |
| Rate for Payer: Aetna Commercial |
$2,569.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,455.30
|
| Rate for Payer: Aetna Managed Medicare |
$799.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,855.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,427.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,370.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,513.15
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$2,626.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,597.66
|
| Rate for Payer: Health EOS Commercial |
$2,540.95
|
| Rate for Payer: HFN Commercial |
$2,626.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,141.25
|
| Rate for Payer: Multiplan Commercial |
$2,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,713.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,626.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,398.95
|
| Rate for Payer: Quartz Commercial |
$1,855.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,713.00
|
| Rate for Payer: The Alliance Commercial |
$11,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,570.25
|
| Rate for Payer: WPS Commercial |
$2,114.70
|
|
|
DRIVER T8 (2.5MM SCREWS) IS1106
|
Facility
OP
|
$2,584.00
|
|
| Hospital Charge Code |
5861646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.52 |
| Max. Negotiated Rate |
$10,336.00 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Aetna Managed Medicare |
$723.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,679.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.01
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,679.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,550.40
|
| Rate for Payer: The Alliance Commercial |
$10,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER T8 (2.5MM SCREWS) IS1106
|
Facility
IP
|
$2,584.00
|
|
| Hospital Charge Code |
5861646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$2,377.28 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,550.40
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER T9 (3.0MM SCREWS) IS1107
|
Facility
OP
|
$2,584.00
|
|
| Hospital Charge Code |
5831691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.52 |
| Max. Negotiated Rate |
$10,336.00 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Aetna Managed Medicare |
$723.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,679.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.01
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,679.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,550.40
|
| Rate for Payer: The Alliance Commercial |
$10,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER T9 (3.0MM SCREWS) IS1107
|
Facility
IP
|
$2,584.00
|
|
| Hospital Charge Code |
5831691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$2,377.28 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,550.40
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER TIP 2.5MM CANNULATED ACUTRAK HT-1725
|
Facility
IP
|
$3,021.00
|
|
| Hospital Charge Code |
4206005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.29 |
| Max. Negotiated Rate |
$2,779.32 |
| Rate for Payer: Aetna Commercial |
$2,718.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.13
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,779.32
|
| Rate for Payer: Health EOS Commercial |
$2,688.69
|
| Rate for Payer: HFN Commercial |
$2,779.32
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.29
|
| Rate for Payer: Quartz Commercial |
$1,812.60
|
| Rate for Payer: WEA Trust Commercial |
$1,661.55
|
| Rate for Payer: WPS Commercial |
$2,237.65
|
|
|
DRIVER TIP 2.5MM CANNULATED ACUTRAK HT-1725
|
Facility
OP
|
$3,021.00
|
|
| Hospital Charge Code |
4206005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$12,084.00 |
| Rate for Payer: Aetna Commercial |
$2,718.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.06
|
| Rate for Payer: Aetna Managed Medicare |
$845.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,963.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,510.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.13
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,779.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,690.55
|
| Rate for Payer: Health EOS Commercial |
$2,688.69
|
| Rate for Payer: HFN Commercial |
$2,779.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.75
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.29
|
| Rate for Payer: Quartz Commercial |
$1,963.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,812.60
|
| Rate for Payer: The Alliance Commercial |
$12,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,661.55
|
| Rate for Payer: WPS Commercial |
$2,237.65
|
|
|
DRIVER TIP CANNULATED ACUTRAK 2 HT-1120
|
Facility
IP
|
$3,086.00
|
|
| Hospital Charge Code |
3901368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,512.14 |
| Max. Negotiated Rate |
$2,839.12 |
| Rate for Payer: Aetna Commercial |
$2,777.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.58
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,839.12
|
| Rate for Payer: Health EOS Commercial |
$2,746.54
|
| Rate for Payer: HFN Commercial |
$2,839.12
|
| Rate for Payer: Multiplan Commercial |
$2,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,851.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.14
|
| Rate for Payer: Quartz Commercial |
$1,851.60
|
| Rate for Payer: WEA Trust Commercial |
$1,697.30
|
| Rate for Payer: WPS Commercial |
$2,285.80
|
|
|
DRIVER TIP CANNULATED ACUTRAK 2 HT-1120
|
Facility
OP
|
$3,086.00
|
|
| Hospital Charge Code |
3901368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.08 |
| Max. Negotiated Rate |
$12,344.00 |
| Rate for Payer: Quartz Beloit One Network |
$1,512.14
|
| Rate for Payer: Aetna Commercial |
$2,777.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,653.96
|
| Rate for Payer: Aetna Managed Medicare |
$864.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,005.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,481.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.58
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,839.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,726.93
|
| Rate for Payer: Health EOS Commercial |
$2,746.54
|
| Rate for Payer: HFN Commercial |
$2,839.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,314.50
|
| Rate for Payer: Multiplan Commercial |
$2,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,851.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.12
|
| Rate for Payer: Quartz Commercial |
$2,005.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,851.60
|
| Rate for Payer: The Alliance Commercial |
$12,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,697.30
|
| Rate for Payer: WPS Commercial |
$2,285.80
|
|
|
DROP DOWN PLUG STEM 5950-67
|
Facility
OP
|
$6,407.00
|
|
| Hospital Charge Code |
2967782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,793.96 |
| Max. Negotiated Rate |
$25,628.00 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,510.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,164.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,075.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,585.36
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,805.25
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$4,164.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,844.20
|
| Rate for Payer: The Alliance Commercial |
$25,628.00
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
|
DROP DOWN PLUG STEM 5950-67
|
Facility
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2967782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.43 |
| Max. Negotiated Rate |
$5,894.44 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$3,844.20
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
|
Drug Challenge During Cath
|
Facility
IP
|
$2,158.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
4510689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,057.42 |
| Max. Negotiated Rate |
$1,985.36 |
| Rate for Payer: Aetna Commercial |
$1,942.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,143.74
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: Health EOS Commercial |
$1,920.62
|
| Rate for Payer: HFN Commercial |
$1,985.36
|
| Rate for Payer: Multiplan Commercial |
$1,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,294.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,985.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.42
|
| Rate for Payer: Quartz Commercial |
$1,294.80
|
| Rate for Payer: WEA Trust Commercial |
$1,186.90
|
| Rate for Payer: WPS Commercial |
$1,598.43
|
|
|
Drug Challenge During Cath
|
Facility
OP
|
$2,158.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
4510689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$604.24 |
| Max. Negotiated Rate |
$1,985.36 |
| Rate for Payer: Aetna Commercial |
$1,942.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,855.88
|
| Rate for Payer: Aetna Managed Medicare |
$604.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,402.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,079.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,035.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,143.74
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: Health EOS Commercial |
$1,920.62
|
| Rate for Payer: HFN Commercial |
$1,985.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,618.50
|
| Rate for Payer: Multiplan Commercial |
$1,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,294.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,985.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.42
|
| Rate for Payer: Quartz Commercial |
$1,402.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,294.80
|
| Rate for Payer: WEA Trust Commercial |
$1,186.90
|
| Rate for Payer: WPS Commercial |
$1,598.43
|
|
|
Drug Coated Balloon 40mm-120mm
|
Facility
OP
|
$7,037.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
5184612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,970.36 |
| Max. Negotiated Rate |
$6,474.04 |
| Rate for Payer: Aetna Commercial |
$6,333.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,051.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,970.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,574.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,518.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,377.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,729.61
|
| Rate for Payer: Cash Price |
$2,111.10
|
| Rate for Payer: Cigna Commercial |
$6,474.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,937.91
|
| Rate for Payer: Health EOS Commercial |
$6,262.93
|
| Rate for Payer: HFN Commercial |
$6,474.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,277.75
|
| Rate for Payer: Multiplan Commercial |
$5,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,222.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,474.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.13
|
| Rate for Payer: Quartz Commercial |
$4,574.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,222.20
|
| Rate for Payer: WEA Trust Commercial |
$3,870.35
|
| Rate for Payer: WPS Commercial |
$5,212.31
|
|
|
Drug Coated Balloon 40mm-120mm
|
Facility
IP
|
$7,037.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
5184612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.13 |
| Max. Negotiated Rate |
$6,474.04 |
| Rate for Payer: Aetna Commercial |
$6,333.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,729.61
|
| Rate for Payer: Cash Price |
$2,111.10
|
| Rate for Payer: Cigna Commercial |
$6,474.04
|
| Rate for Payer: Health EOS Commercial |
$6,262.93
|
| Rate for Payer: HFN Commercial |
$6,474.04
|
| Rate for Payer: Multiplan Commercial |
$5,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,222.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,474.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.13
|
| Rate for Payer: Quartz Commercial |
$4,222.20
|
| Rate for Payer: WEA Trust Commercial |
$3,870.35
|
| Rate for Payer: WPS Commercial |
$5,212.31
|
|
|
Drug Screen Panel 7, Serum
|
Professional
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$245.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$273.42
|
|
|
Drug Screen Panel 7, Serum
|
Facility
IP
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Drug Screen Panel 7, Serum
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.15
|
| Rate for Payer: Anthem Medicaid |
$63.40
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Managed Health Services Medicaid |
$65.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Drug Screen Panel 8, Serum
|
Facility
OP
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.15
|
| Rate for Payer: Anthem Medicaid |
$63.40
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Managed Health Services Medicaid |
$65.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Healthcare PPO |
$229.50
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Drug Screen Panel 8, Serum
|
Facility
IP
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Drug Screen Panel 8, Serum
|
Professional
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$278.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$290.70
|
| Rate for Payer: Quartz Beloit One Network |
$134.64
|
| Rate for Payer: Quartz Commercial |
$174.42
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$245.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$273.42
|
|
