|
GLIDEWIRE GI .035 260cm 5191
|
Facility
|
OP
|
$1,827.00
|
|
| Hospital Charge Code |
2973626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.56 |
| Max. Negotiated Rate |
$7,308.00 |
| Rate for Payer: Aetna Commercial |
$1,644.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.22
|
| Rate for Payer: Aetna Managed Medicare |
$511.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$876.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.31
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,680.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.39
|
| Rate for Payer: Health EOS Commercial |
$1,626.03
|
| Rate for Payer: HFN Commercial |
$1,680.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.25
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.84
|
| Rate for Payer: Quartz Beloit One Network |
$895.23
|
| Rate for Payer: Quartz Commercial |
$1,187.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.20
|
| Rate for Payer: The Alliance Commercial |
$7,308.00
|
| Rate for Payer: WEA Trust Commercial |
$1,004.85
|
| Rate for Payer: WPS Commercial |
$1,353.26
|
|
|
GLIDEWIRE GI .035 260cm 5191
|
Facility
|
IP
|
$1,827.00
|
|
| Hospital Charge Code |
2973626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$895.23 |
| Max. Negotiated Rate |
$1,680.84 |
| Rate for Payer: Aetna Commercial |
$1,644.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.31
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,680.84
|
| Rate for Payer: Health EOS Commercial |
$1,626.03
|
| Rate for Payer: HFN Commercial |
$1,680.84
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.84
|
| Rate for Payer: Quartz Beloit One Network |
$895.23
|
| Rate for Payer: Quartz Commercial |
$1,096.20
|
| Rate for Payer: WEA Trust Commercial |
$1,004.85
|
| Rate for Payer: WPS Commercial |
$1,353.26
|
|
|
GLIDING SURFACE VEGA PS T2/2+ 12MM NX121
|
Facility
|
OP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.04 |
| Max. Negotiated Rate |
$19,672.00 |
| Rate for Payer: Aetna Commercial |
$4,426.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,196.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,360.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.54
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,524.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,752.11
|
| Rate for Payer: Health EOS Commercial |
$4,377.02
|
| Rate for Payer: HFN Commercial |
$4,524.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,688.50
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.82
|
| Rate for Payer: Quartz Commercial |
$3,196.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,950.80
|
| Rate for Payer: The Alliance Commercial |
$19,672.00
|
| Rate for Payer: WEA Trust Commercial |
$2,704.90
|
| Rate for Payer: WPS Commercial |
$3,642.76
|
|
|
GLIDING SURFACE VEGA PS T2/2+ 12MM NX121
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.82 |
| Max. Negotiated Rate |
$4,524.56 |
| Rate for Payer: Aetna Commercial |
$4,426.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.54
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,524.56
|
| Rate for Payer: Health EOS Commercial |
$4,377.02
|
| Rate for Payer: HFN Commercial |
$4,524.56
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.82
|
| Rate for Payer: Quartz Commercial |
$2,950.80
|
| Rate for Payer: WEA Trust Commercial |
$2,704.90
|
| Rate for Payer: WPS Commercial |
$3,642.76
|
|
|
GLIDING SURFACE VEGA PS T3/3+ 12MM NX131
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.82 |
| Max. Negotiated Rate |
$4,524.56 |
| Rate for Payer: Aetna Commercial |
$4,426.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.54
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,524.56
|
| Rate for Payer: Health EOS Commercial |
$4,377.02
|
| Rate for Payer: HFN Commercial |
$4,524.56
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.82
|
| Rate for Payer: Quartz Commercial |
$2,950.80
|
| Rate for Payer: WEA Trust Commercial |
$2,704.90
|
| Rate for Payer: WPS Commercial |
$3,642.76
|
|
|
GLIDING SURFACE VEGA PS T3/3+ 12MM NX131
|
Facility
|
OP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.04 |
| Max. Negotiated Rate |
$19,672.00 |
| Rate for Payer: Aetna Commercial |
$4,426.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,196.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,360.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.54
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,524.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,752.11
|
| Rate for Payer: Health EOS Commercial |
$4,377.02
|
| Rate for Payer: HFN Commercial |
$4,524.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,688.50
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.82
|
| Rate for Payer: Quartz Commercial |
$3,196.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,950.80
|
| Rate for Payer: The Alliance Commercial |
$19,672.00
|
| Rate for Payer: WEA Trust Commercial |
$2,704.90
|
| Rate for Payer: WPS Commercial |
$3,642.76
|
|
|
Glidin Peptide IgA
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgA
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$100.10
|
| Rate for Payer: HFN Commercial |
$104.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.50
|
| Rate for Payer: Quartz Beloit One Network |
$48.40
|
| Rate for Payer: Quartz Commercial |
$62.70
|
| Rate for Payer: The Alliance Commercial |
$55.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgA
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$82.50
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgA & IgG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$100.10
|
| Rate for Payer: HFN Commercial |
$104.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.50
|
| Rate for Payer: Quartz Beloit One Network |
$48.40
|
| Rate for Payer: Quartz Commercial |
$62.70
|
| Rate for Payer: The Alliance Commercial |
$55.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgA & IgG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$82.50
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgA & IgG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$100.10
|
| Rate for Payer: HFN Commercial |
$104.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.50
|
| Rate for Payer: Quartz Beloit One Network |
$48.40
|
| Rate for Payer: Quartz Commercial |
$62.70
|
| Rate for Payer: The Alliance Commercial |
$55.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$82.50
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Glidin Peptide IgG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2808801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
|
Facility
|
OP
|
$23,153.12
|
|
|
Service Code
|
CPT 41120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$23,153.12 |
| Rate for Payer: Aetna Managed Medicare |
$5,788.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,788.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,788.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,788.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,532.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,788.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,788.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,788.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,788.28
|
| Rate for Payer: NAPHCARE Commercial |
$8,682.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,788.28
|
| Rate for Payer: The Alliance Commercial |
$23,153.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,788.28
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,788.28
|
|
|
GLOSSECTOMY, PARTIAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960088
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
GLOSSECTOMY, PARTIAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960088
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
GLOVE COMPRESSION XX-LRG LEFT
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
2971563
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$344.96 |
| Max. Negotiated Rate |
$647.68 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$422.40
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
GLOVE COMPRESSION XX-LRG LEFT
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
2971563
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$2,816.00 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Aetna Managed Medicare |
$197.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$457.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$337.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.96
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$457.60
|
| Rate for Payer: Quartz Medicare Advantage |
$422.40
|
| Rate for Payer: The Alliance Commercial |
$2,816.00
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
GLOVE DELUX TRACTION LF w/THUMB LG/XLG #5506-29
|
Facility
|
IP
|
$459.00
|
|
| Hospital Charge Code |
2971263
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$224.91 |
| Max. Negotiated Rate |
$422.28 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.27
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cigna Commercial |
$422.28
|
| Rate for Payer: Health EOS Commercial |
$408.51
|
| Rate for Payer: HFN Commercial |
$422.28
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: NAPHCARE Commercial |
$275.40
|
| Rate for Payer: Preferred Network Access Commercial |
$422.28
|
| Rate for Payer: Quartz Beloit One Network |
$224.91
|
| Rate for Payer: Quartz Commercial |
$275.40
|
| Rate for Payer: WEA Trust Commercial |
$252.45
|
| Rate for Payer: WPS Commercial |
$339.98
|
|
|
GLOVE DELUX TRACTION LF w/THUMB LG/XLG #5506-29
|
Facility
|
OP
|
$459.00
|
|
| Hospital Charge Code |
2971263
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.74
|
| Rate for Payer: Aetna Managed Medicare |
$128.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$298.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.27
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cigna Commercial |
$422.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.86
|
| Rate for Payer: Health EOS Commercial |
$408.51
|
| Rate for Payer: HFN Commercial |
$422.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.25
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: NAPHCARE Commercial |
$275.40
|
| Rate for Payer: Preferred Network Access Commercial |
$422.28
|
| Rate for Payer: Quartz Beloit One Network |
$224.91
|
| Rate for Payer: Quartz Commercial |
$298.35
|
| Rate for Payer: Quartz Medicare Advantage |
$275.40
|
| Rate for Payer: The Alliance Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$252.45
|
| Rate for Payer: WPS Commercial |
$339.98
|
|
|
GLOVE DELUX TRACTION RT w/THUMB LG/XLG #5506-28
|
Facility
|
IP
|
$474.00
|
|
| Hospital Charge Code |
2971280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.26 |
| Max. Negotiated Rate |
$436.08 |
| Rate for Payer: Aetna Commercial |
$426.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.22
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$436.08
|
| Rate for Payer: Health EOS Commercial |
$421.86
|
| Rate for Payer: HFN Commercial |
$436.08
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: NAPHCARE Commercial |
$284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$436.08
|
| Rate for Payer: Quartz Beloit One Network |
$232.26
|
| Rate for Payer: Quartz Commercial |
$284.40
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
GLOVE DELUX TRACTION RT w/THUMB LG/XLG #5506-28
|
Facility
|
OP
|
$474.00
|
|
| Hospital Charge Code |
2971280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$1,896.00 |
| Rate for Payer: Aetna Commercial |
$426.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Aetna Managed Medicare |
$132.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.22
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$436.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.25
|
| Rate for Payer: Health EOS Commercial |
$421.86
|
| Rate for Payer: HFN Commercial |
$436.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.50
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: NAPHCARE Commercial |
$284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$436.08
|
| Rate for Payer: Quartz Beloit One Network |
$232.26
|
| Rate for Payer: Quartz Commercial |
$308.10
|
| Rate for Payer: Quartz Medicare Advantage |
$284.40
|
| Rate for Payer: The Alliance Commercial |
$1,896.00
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
GLOVE EDEMA 3/4 FINGER MED (L) #9274-41-02
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
2969792
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$63.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$135.00
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
