|
NAIL TROCHANTERIC TFNA 12MMX125 DEG 320MM RT TI 04.037.222S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$43,200.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,024.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,020.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,043.68
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,100.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$7,020.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,480.00
|
| Rate for Payer: The Alliance Commercial |
$43,200.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 12MMX125 DEG 320MM RT TI 04.037.222S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,292.00 |
| Max. Negotiated Rate |
$9,936.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$6,480.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 12MMX125 DEG TI RT 04.037.214S
|
Facility
|
IP
|
$9,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5306837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,515.84 |
| Max. Negotiated Rate |
$8,478.72 |
| Rate for Payer: Aetna Commercial |
$8,294.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,925.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,884.48
|
| Rate for Payer: Cash Price |
$2,764.80
|
| Rate for Payer: Cigna Commercial |
$8,478.72
|
| Rate for Payer: Health EOS Commercial |
$8,202.24
|
| Rate for Payer: HFN Commercial |
$8,478.72
|
| Rate for Payer: Multiplan Commercial |
$7,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,529.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,478.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,515.84
|
| Rate for Payer: Quartz Commercial |
$5,529.60
|
| Rate for Payer: WEA Trust Commercial |
$5,068.80
|
| Rate for Payer: WPS Commercial |
$6,826.29
|
|
|
NAIL TROCHANTERIC TFNA 12MMX125 DEG TI RT 04.037.214S
|
Facility
|
OP
|
$9,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5306837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.48 |
| Max. Negotiated Rate |
$36,864.00 |
| Rate for Payer: Aetna Commercial |
$8,294.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,925.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,580.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,990.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,423.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,884.48
|
| Rate for Payer: Cash Price |
$2,764.80
|
| Rate for Payer: Cigna Commercial |
$8,478.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,157.27
|
| Rate for Payer: Health EOS Commercial |
$8,202.24
|
| Rate for Payer: HFN Commercial |
$8,478.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,912.00
|
| Rate for Payer: Multiplan Commercial |
$7,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,529.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,478.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,515.84
|
| Rate for Payer: Quartz Commercial |
$5,990.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,529.60
|
| Rate for Payer: The Alliance Commercial |
$36,864.00
|
| Rate for Payer: WEA Trust Commercial |
$5,068.80
|
| Rate for Payer: WPS Commercial |
$6,826.29
|
|
|
NAIL TROCHANTERIC TI 11MM/125D
|
Facility
|
IP
|
$10,864.00
|
|
| Hospital Charge Code |
2966302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,323.36 |
| Max. Negotiated Rate |
$9,994.88 |
| Rate for Payer: Aetna Commercial |
$9,777.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,343.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,757.92
|
| Rate for Payer: Cash Price |
$3,259.20
|
| Rate for Payer: Cigna Commercial |
$9,994.88
|
| Rate for Payer: Health EOS Commercial |
$9,668.96
|
| Rate for Payer: HFN Commercial |
$9,994.88
|
| Rate for Payer: Multiplan Commercial |
$8,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,994.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,323.36
|
| Rate for Payer: Quartz Commercial |
$6,518.40
|
| Rate for Payer: WEA Trust Commercial |
$5,975.20
|
| Rate for Payer: WPS Commercial |
$8,046.96
|
|
|
NAIL TROCHANTERIC TI 11MM/125D
|
Facility
|
OP
|
$10,864.00
|
|
| Hospital Charge Code |
2966302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,041.92 |
| Max. Negotiated Rate |
$43,456.00 |
| Rate for Payer: Aetna Commercial |
$9,777.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,343.04
|
| Rate for Payer: Aetna Managed Medicare |
$3,041.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,061.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,432.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,214.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,757.92
|
| Rate for Payer: Cash Price |
$3,259.20
|
| Rate for Payer: Cigna Commercial |
$9,994.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,079.49
|
| Rate for Payer: Health EOS Commercial |
$9,668.96
|
| Rate for Payer: HFN Commercial |
$9,994.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,148.00
|
| Rate for Payer: Multiplan Commercial |
$8,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,994.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,323.36
|
| Rate for Payer: Quartz Commercial |
$7,061.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,518.40
|
| Rate for Payer: The Alliance Commercial |
$43,456.00
|
| Rate for Payer: WEA Trust Commercial |
$5,975.20
|
| Rate for Payer: WPS Commercial |
$8,046.96
|
|
|
NAIL WITH COMPRESSION SCREW 8MM X 100MM 2380-0811S
|
Facility
|
OP
|
$13,454.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,767.12 |
| Max. Negotiated Rate |
$53,816.00 |
| Rate for Payer: Aetna Commercial |
$12,108.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,570.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,767.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,745.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,727.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,457.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,130.62
|
| Rate for Payer: Cash Price |
$4,036.20
|
| Rate for Payer: Cigna Commercial |
$12,377.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,528.86
|
| Rate for Payer: Health EOS Commercial |
$11,974.06
|
| Rate for Payer: HFN Commercial |
$12,377.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,090.50
|
| Rate for Payer: Multiplan Commercial |
$10,763.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,072.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,377.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,592.46
|
| Rate for Payer: Quartz Commercial |
$8,745.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8,072.40
|
| Rate for Payer: The Alliance Commercial |
$53,816.00
|
| Rate for Payer: WEA Trust Commercial |
$7,399.70
|
| Rate for Payer: WPS Commercial |
$9,965.38
|
|
|
NAIL WITH COMPRESSION SCREW 8MM X 100MM 2380-0811S
|
Facility
|
IP
|
$13,454.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,592.46 |
| Max. Negotiated Rate |
$12,377.68 |
| Rate for Payer: Aetna Commercial |
$12,108.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,570.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,130.62
|
| Rate for Payer: Cash Price |
$4,036.20
|
| Rate for Payer: Cigna Commercial |
$12,377.68
|
| Rate for Payer: Health EOS Commercial |
$11,974.06
|
| Rate for Payer: HFN Commercial |
$12,377.68
|
| Rate for Payer: Multiplan Commercial |
$10,763.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,072.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,377.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,592.46
|
| Rate for Payer: Quartz Commercial |
$8,072.40
|
| Rate for Payer: WEA Trust Commercial |
$7,399.70
|
| Rate for Payer: WPS Commercial |
$9,965.38
|
|
|
naloxone 0.4 mg/mL Inj Syr [Med]
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
2983102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
naloxone 0.4 mg/mL Inj Syr [Med]
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
2983102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$35.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.66
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$76.80
|
| Rate for Payer: The Alliance Commercial |
$512.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$20.14
|
|
|
Naloxone Urine
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
4578685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$752.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Aetna Managed Medicare |
$52.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.20
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| Rate for Payer: Quartz Medicare Advantage |
$112.80
|
| Rate for Payer: The Alliance Commercial |
$752.00
|
| Rate for Payer: United Healthcare PPO |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Naloxone Urine
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
4578685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$178.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.80
|
| Rate for Payer: Health EOS Commercial |
$171.08
|
| Rate for Payer: HFN Commercial |
$178.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.60
|
| Rate for Payer: Quartz Beloit One Network |
$82.72
|
| Rate for Payer: Quartz Commercial |
$107.16
|
| Rate for Payer: The Alliance Commercial |
$94.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Naloxone Urine
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
4578685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$112.80
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Nano 1.5mm x 20mm 150cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 1.5mm x 20mm 150cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 1.5mm x 20mm 150cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 120mm 150cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 120mm 150cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 120mm 150cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 150mm 150cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 150mm 150cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 150mm 150cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 20mm 150cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 20mm 150cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Nano 2.0mm x 20mm 150cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2546966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
