|
GUIDE WIRE STORQ .035 300cm (ORDER IS MULTIPLES OF FIVE) 503356Y
|
Facility
|
OP
|
$1,347.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.16 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$1,212.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,158.42
|
| Rate for Payer: Aetna Managed Medicare |
$377.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$875.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.91
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,239.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.78
|
| Rate for Payer: Health EOS Commercial |
$1,198.83
|
| Rate for Payer: HFN Commercial |
$1,239.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.25
|
| Rate for Payer: Multiplan Commercial |
$1,077.60
|
| Rate for Payer: NAPHCARE Commercial |
$808.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,239.24
|
| Rate for Payer: Quartz Beloit One Network |
$660.03
|
| Rate for Payer: Quartz Commercial |
$875.55
|
| Rate for Payer: Quartz Medicare Advantage |
$808.20
|
| Rate for Payer: The Alliance Commercial |
$5,388.00
|
| Rate for Payer: WEA Trust Commercial |
$740.85
|
| Rate for Payer: WPS Commercial |
$997.72
|
|
|
GUIDEWIRE STRAIGHT #M00551981
|
Facility
|
IP
|
$1,827.00
|
|
| Hospital Charge Code |
2973627
|
|
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
|
|
|
GUIDEWIRE STRAIGHT #M00551981
|
Facility
|
OP
|
$1,827.00
|
|
| Hospital Charge Code |
2973627
|
|
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
|
|
|
GUIDE WIRE WHISPER .014 J 300CM
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.84 |
| Max. Negotiated Rate |
$1,486.72 |
| Rate for Payer: Aetna Commercial |
$1,454.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.48
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: Health EOS Commercial |
$1,438.24
|
| Rate for Payer: HFN Commercial |
$1,486.72
|
| Rate for Payer: Multiplan Commercial |
$1,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$791.84
|
| Rate for Payer: Quartz Commercial |
$969.60
|
| Rate for Payer: WEA Trust Commercial |
$888.80
|
| Rate for Payer: WPS Commercial |
$1,196.97
|
|
|
GUIDE WIRE WHISPER .014 J 300CM
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.48 |
| Max. Negotiated Rate |
$6,464.00 |
| Rate for Payer: Aetna Commercial |
$1,454.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.76
|
| Rate for Payer: Aetna Managed Medicare |
$452.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,050.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$808.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.48
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$904.31
|
| Rate for Payer: Health EOS Commercial |
$1,438.24
|
| Rate for Payer: HFN Commercial |
$1,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,212.00
|
| Rate for Payer: Multiplan Commercial |
$1,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$791.84
|
| Rate for Payer: Quartz Commercial |
$1,050.40
|
| Rate for Payer: Quartz Medicare Advantage |
$969.60
|
| Rate for Payer: The Alliance Commercial |
$6,464.00
|
| Rate for Payer: WEA Trust Commercial |
$888.80
|
| Rate for Payer: WPS Commercial |
$1,196.97
|
|
|
GUIDE WIRE WHISPER MS .014 J 190cm
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
GUIDE WIRE WHISPER MS .014 J 190cm
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
GUIDING CATHETER 7FR MP 77827055
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$912.38 |
| Max. Negotiated Rate |
$1,713.04 |
| Rate for Payer: Aetna Commercial |
$1,675.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.86
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,713.04
|
| Rate for Payer: Health EOS Commercial |
$1,657.18
|
| Rate for Payer: HFN Commercial |
$1,713.04
|
| Rate for Payer: Multiplan Commercial |
$1,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.04
|
| Rate for Payer: Quartz Beloit One Network |
$912.38
|
| Rate for Payer: Quartz Commercial |
$1,117.20
|
| Rate for Payer: WEA Trust Commercial |
$1,024.10
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
GUIDING CATHETER 7FR MP 77827055
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.36 |
| Max. Negotiated Rate |
$7,448.00 |
| Rate for Payer: Aetna Commercial |
$1,675.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.32
|
| Rate for Payer: Aetna Managed Medicare |
$521.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.86
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,713.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.98
|
| Rate for Payer: Health EOS Commercial |
$1,657.18
|
| Rate for Payer: HFN Commercial |
$1,713.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.50
|
| Rate for Payer: Multiplan Commercial |
$1,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.04
|
| Rate for Payer: Quartz Beloit One Network |
$912.38
|
| Rate for Payer: Quartz Commercial |
$1,210.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,117.20
|
| Rate for Payer: The Alliance Commercial |
$7,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,024.10
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
GUYON'S CANAL RELEASE
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$4,968.00 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$347.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$807.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$596.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$695.02
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.50
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$807.30
|
| Rate for Payer: Quartz Medicare Advantage |
$745.20
|
| Rate for Payer: The Alliance Commercial |
$4,968.00
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
GUYON'S CANAL RELEASE
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$745.20
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
Gynecological Exam
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
1122843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$130.72 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.20
|
| Rate for Payer: Health EOS Commercial |
$56.42
|
| Rate for Payer: HFN Commercial |
$58.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.72
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Preferred Network Access Commercial |
$58.90
|
| Rate for Payer: Quartz Beloit One Network |
$27.28
|
| Rate for Payer: Quartz Commercial |
$35.34
|
| Rate for Payer: The Alliance Commercial |
$31.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.80
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
H20/CO2 Cystometrogram Compl
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
3005553
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$570.36 |
| Max. Negotiated Rate |
$1,070.88 |
| Rate for Payer: Aetna Commercial |
$1,047.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.92
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,070.88
|
| Rate for Payer: Health EOS Commercial |
$1,035.96
|
| Rate for Payer: HFN Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: NAPHCARE Commercial |
$698.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.88
|
| Rate for Payer: Quartz Beloit One Network |
$570.36
|
| Rate for Payer: Quartz Commercial |
$698.40
|
| Rate for Payer: WEA Trust Commercial |
$640.20
|
| Rate for Payer: WPS Commercial |
$862.17
|
|
|
H20/CO2 Cystometrogram Compl
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
3005553
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$1,047.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.04
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$756.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.72
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,070.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$1,035.96
|
| Rate for Payer: HFN Commercial |
$1,070.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.88
|
| Rate for Payer: Quartz Beloit One Network |
$570.36
|
| Rate for Payer: Quartz Commercial |
$756.60
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$873.00
|
| Rate for Payer: WEA Trust Commercial |
$640.20
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$862.17
|
|
|
Haemophilus influenza Type B Antibody IgG
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86684
|
| Hospital Charge Code |
1124802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$15.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.29
|
| Rate for Payer: Anthem Medicaid |
$16.37
|
| Rate for Payer: Anthem Medicare Advantage |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.84
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$16.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.84
|
| Rate for Payer: Managed Health Services Medicaid |
$17.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$23.76
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.37
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$15.84
|
| Rate for Payer: The Alliance Commercial |
$63.36
|
| Rate for Payer: United Healthcare Medicaid |
$16.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.84
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$15.84
|
| Rate for Payer: WMAP Medicaid |
$16.37
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Haemophilus influenza Type B Antibody IgG
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86684
|
| Hospital Charge Code |
1124802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Haemophilus influenza Type B Antibody IgG
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86684
|
| Hospital Charge Code |
1124802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Haemophilus MIC - Kirby Bauer
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
1562856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Haemophilus MIC - Kirby Bauer
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
1562856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$7.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.42
|
| Rate for Payer: Anthem Medicaid |
$7.73
|
| Rate for Payer: Anthem Medicare Advantage |
$7.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.70
|
| Rate for Payer: Dean Health Medicaid |
$7.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.48
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.48
|
| Rate for Payer: Managed Health Services Medicaid |
$8.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$11.22
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.73
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7.48
|
| Rate for Payer: The Alliance Commercial |
$29.92
|
| Rate for Payer: United Healthcare Medicaid |
$7.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.48
|
| Rate for Payer: United Healthcare PPO |
$109.50
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: Wellcare Medicare |
$7.48
|
| Rate for Payer: WMAP Medicaid |
$7.73
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Haemophilus MIC - Kirby Bauer
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
1562856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.60
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
HAGLUND/HEEL DEFORMITY, RESECTION
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$4,968.00 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$347.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$807.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$596.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$695.02
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.50
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$807.30
|
| Rate for Payer: Quartz Medicare Advantage |
$745.20
|
| Rate for Payer: The Alliance Commercial |
$4,968.00
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
HAGLUND/HEEL DEFORMITY, RESECTION
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$745.20
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 10MM 5546-A-101
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5240747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 10MM 5546-A-101
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5240747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 5MM 5546-A-102
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5240745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
