|
FILL KIT IMPLANT 350-8400
|
Facility
|
OP
|
$397.00
|
|
| Hospital Charge Code |
2969473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Aetna Managed Medicare |
$115.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.05
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.66
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: NAPHCARE Commercial |
$247.73
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$268.37
|
| Rate for Payer: Quartz Medicare Advantage |
$247.73
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
FILL KIT IMPLANT/EXPANDER
|
Facility
|
IP
|
$397.00
|
|
| Hospital Charge Code |
2974025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$247.73
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
FILL KIT IMPLANT/EXPANDER
|
Facility
|
OP
|
$397.00
|
|
| Hospital Charge Code |
2974025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Aetna Managed Medicare |
$115.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.05
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.66
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: NAPHCARE Commercial |
$247.73
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$268.37
|
| Rate for Payer: Quartz Medicare Advantage |
$247.73
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
FILTER AIR INLET #88-M1161007
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2971097
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
FILTER AIR INLET #88-M1161007
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2971097
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.82
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$43.06
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$43.06
|
| Rate for Payer: The Alliance Commercial |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
FILTER AIR INLET V60 1054279
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
2971774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$72.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$154.75
|
| Rate for Payer: The Alliance Commercial |
$128.96
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
FILTER AIR INLET V60 1054279
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
2971774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
FILTER BACTERIA VIRAL RHF605U
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
2974553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.21
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: NAPHCARE Commercial |
$20.59
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$22.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.59
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
FILTER BACTERIA VIRAL RHF605U
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
2974553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$20.59
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
FILTER BLOOD TRANSFUSION PALL SQ40S
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2973503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
FILTER BLOOD TRANSFUSION PALL SQ40S
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2973503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
FILTER COOLING FAN V60 1054280
|
Facility
|
IP
|
$67.00
|
|
| Hospital Charge Code |
2970863
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
FILTER COOLING FAN V60 1054280
|
Facility
|
OP
|
$67.00
|
|
| Hospital Charge Code |
2970863
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.26
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$41.81
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$41.81
|
| Rate for Payer: The Alliance Commercial |
$34.84
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
FILTER, HME, SMALL VOLUME #BB25A
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
2973475
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.71 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$52.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.34
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$112.94
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$112.94
|
| Rate for Payer: The Alliance Commercial |
$94.12
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
FILTER, HME, SMALL VOLUME #BB25A
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
2973475
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$92.24 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$112.94
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
FILTER NEPTUNE SMOKE EVAC PREFILTER 700-22
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
4294571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
FILTER NEPTUNE SMOKE EVAC PREFILTER 700-22
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
4294571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$109.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$253.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.25
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
FILTER SMOKE EVACUATION ULPA
|
Facility
|
IP
|
$1,684.00
|
|
| Hospital Charge Code |
2967382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Aetna Commercial |
$1,576.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.22
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,611.25
|
| Rate for Payer: Health EOS Commercial |
$1,558.71
|
| Rate for Payer: HFN Commercial |
$1,611.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.25
|
| Rate for Payer: Quartz Beloit One Network |
$858.17
|
| Rate for Payer: Quartz Commercial |
$1,050.82
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,297.19
|
|
|
FILTER SMOKE EVACUATION ULPA
|
Facility
|
OP
|
$1,684.00
|
|
| Hospital Charge Code |
2967382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.38 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Aetna Commercial |
$1,576.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Aetna Managed Medicare |
$490.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.22
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,611.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.09
|
| Rate for Payer: Health EOS Commercial |
$1,558.71
|
| Rate for Payer: HFN Commercial |
$1,611.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.52
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.25
|
| Rate for Payer: Quartz Beloit One Network |
$858.17
|
| Rate for Payer: Quartz Commercial |
$1,138.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.82
|
| Rate for Payer: The Alliance Commercial |
$875.68
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,297.19
|
|
|
FILTER VAPOR-CLEAN #101
|
Facility
|
IP
|
$1,162.00
|
|
| Hospital Charge Code |
2973603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.16 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Aetna Commercial |
$1,087.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,039.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.49
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,111.80
|
| Rate for Payer: Health EOS Commercial |
$1,075.55
|
| Rate for Payer: HFN Commercial |
$1,111.80
|
| Rate for Payer: Multiplan Commercial |
$966.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.80
|
| Rate for Payer: Quartz Beloit One Network |
$592.16
|
| Rate for Payer: Quartz Commercial |
$725.09
|
| Rate for Payer: WEA Trust Commercial |
$664.66
|
| Rate for Payer: WPS Commercial |
$895.09
|
|
|
FILTER VAPOR-CLEAN #101
|
Facility
|
OP
|
$1,162.00
|
|
| Hospital Charge Code |
2973603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Aetna Commercial |
$1,087.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,039.29
|
| Rate for Payer: Aetna Managed Medicare |
$338.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$785.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$604.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$580.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.49
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,111.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$676.28
|
| Rate for Payer: Health EOS Commercial |
$1,075.55
|
| Rate for Payer: HFN Commercial |
$1,111.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$906.36
|
| Rate for Payer: Multiplan Commercial |
$966.78
|
| Rate for Payer: NAPHCARE Commercial |
$725.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.80
|
| Rate for Payer: Quartz Beloit One Network |
$592.16
|
| Rate for Payer: Quartz Commercial |
$785.51
|
| Rate for Payer: Quartz Medicare Advantage |
$725.09
|
| Rate for Payer: The Alliance Commercial |
$604.24
|
| Rate for Payer: WEA Trust Commercial |
$664.66
|
| Rate for Payer: WPS Commercial |
$895.09
|
|
|
FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL 10004
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
CPT 10004
|
| Hospital Charge Code |
6209341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$450.53 |
| Rate for Payer: Aetna Commercial |
$450.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Aetna Managed Medicare |
$34.81
|
| Rate for Payer: Anthem Medicare Advantage |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.81
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$450.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.81
|
| Rate for Payer: Health EOS Commercial |
$431.56
|
| Rate for Payer: HFN Commercial |
$450.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.81
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: NAPHCARE Commercial |
$52.21
|
| Rate for Payer: Preferred Network Access Commercial |
$450.53
|
| Rate for Payer: Quartz Beloit One Network |
$208.67
|
| Rate for Payer: Quartz Commercial |
$270.32
|
| Rate for Payer: Quartz Medicare Advantage |
$34.81
|
| Rate for Payer: The Alliance Commercial |
$147.94
|
| Rate for Payer: United Healthcare Medicaid |
$41.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.81
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$60.92
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 10005
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
5464668
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.47 |
| Max. Negotiated Rate |
$546.36 |
| Rate for Payer: Aetna Commercial |
$546.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Aetna Managed Medicare |
$60.47
|
| Rate for Payer: Anthem Medicare Advantage |
$60.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.47
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$546.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.47
|
| Rate for Payer: Health EOS Commercial |
$523.36
|
| Rate for Payer: HFN Commercial |
$546.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$253.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.47
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: NAPHCARE Commercial |
$90.70
|
| Rate for Payer: Preferred Network Access Commercial |
$546.36
|
| Rate for Payer: Quartz Beloit One Network |
$253.05
|
| Rate for Payer: Quartz Commercial |
$327.82
|
| Rate for Payer: Quartz Medicare Advantage |
$60.47
|
| Rate for Payer: The Alliance Commercial |
$256.98
|
| Rate for Payer: United Healthcare Medicaid |
$102.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.47
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$105.81
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL 10006
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
5464669
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$258.86 |
| Rate for Payer: Aetna Commercial |
$258.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$41.87
|
| Rate for Payer: Anthem Medicare Advantage |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.87
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$258.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.87
|
| Rate for Payer: Health EOS Commercial |
$247.96
|
| Rate for Payer: HFN Commercial |
$258.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.87
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$62.81
|
| Rate for Payer: Preferred Network Access Commercial |
$258.86
|
| Rate for Payer: Quartz Beloit One Network |
$119.89
|
| Rate for Payer: Quartz Commercial |
$155.31
|
| Rate for Payer: Quartz Medicare Advantage |
$41.87
|
| Rate for Payer: The Alliance Commercial |
$177.95
|
| Rate for Payer: United Healthcare Medicaid |
$48.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$73.27
|
|
|
Fine Needle Aspiration - Quest
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3114201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$527.96
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: United Healthcare PPO |
$609.18
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
