|
PACK MAJOR VASCULAR CUSTOM DYNJ30564I
|
Facility
|
OP
|
$1,821.00
|
|
| Hospital Charge Code |
2963036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.88 |
| Max. Negotiated Rate |
$7,284.00 |
| Rate for Payer: Aetna Commercial |
$1,638.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.06
|
| Rate for Payer: Aetna Managed Medicare |
$509.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.13
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,675.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.03
|
| Rate for Payer: Health EOS Commercial |
$1,620.69
|
| Rate for Payer: HFN Commercial |
$1,675.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.75
|
| Rate for Payer: Multiplan Commercial |
$1,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.32
|
| Rate for Payer: Quartz Beloit One Network |
$892.29
|
| Rate for Payer: Quartz Commercial |
$1,183.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.60
|
| Rate for Payer: The Alliance Commercial |
$7,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.55
|
| Rate for Payer: WPS Commercial |
$1,348.81
|
|
|
PACK MAJOR VASCULAR CUSTOM DYNJ30564I
|
Facility
|
IP
|
$1,821.00
|
|
| Hospital Charge Code |
2963036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.29 |
| Max. Negotiated Rate |
$1,675.32 |
| Rate for Payer: Aetna Commercial |
$1,638.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.13
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,675.32
|
| Rate for Payer: Health EOS Commercial |
$1,620.69
|
| Rate for Payer: HFN Commercial |
$1,675.32
|
| Rate for Payer: Multiplan Commercial |
$1,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.32
|
| Rate for Payer: Quartz Beloit One Network |
$892.29
|
| Rate for Payer: Quartz Commercial |
$1,092.60
|
| Rate for Payer: WEA Trust Commercial |
$1,001.55
|
| Rate for Payer: WPS Commercial |
$1,348.81
|
|
|
PACK MINOR CUSTOM DYNJ30560F
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
2963110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$1,880.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Aetna Managed Medicare |
$131.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$305.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.10
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$432.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.01
|
| Rate for Payer: Health EOS Commercial |
$418.30
|
| Rate for Payer: HFN Commercial |
$432.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$352.50
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: NAPHCARE Commercial |
$282.00
|
| Rate for Payer: Preferred Network Access Commercial |
$432.40
|
| Rate for Payer: Quartz Beloit One Network |
$230.30
|
| Rate for Payer: Quartz Commercial |
$305.50
|
| Rate for Payer: Quartz Medicare Advantage |
$282.00
|
| Rate for Payer: The Alliance Commercial |
$1,880.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
PACK MINOR CUSTOM DYNJ30560F
|
Facility
|
IP
|
$470.00
|
|
| Hospital Charge Code |
2963110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.30 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.10
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$432.40
|
| Rate for Payer: Health EOS Commercial |
$418.30
|
| Rate for Payer: HFN Commercial |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: NAPHCARE Commercial |
$282.00
|
| Rate for Payer: Preferred Network Access Commercial |
$432.40
|
| Rate for Payer: Quartz Beloit One Network |
$230.30
|
| Rate for Payer: Quartz Commercial |
$282.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
PACK PHACO ADD #DP4310
|
Facility
|
IP
|
$978.00
|
|
| Hospital Charge Code |
2962989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.22 |
| Max. Negotiated Rate |
$899.76 |
| Rate for Payer: Aetna Commercial |
$880.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$841.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.34
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna Commercial |
$899.76
|
| Rate for Payer: Health EOS Commercial |
$870.42
|
| Rate for Payer: HFN Commercial |
$899.76
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: NAPHCARE Commercial |
$586.80
|
| Rate for Payer: Preferred Network Access Commercial |
$899.76
|
| Rate for Payer: Quartz Beloit One Network |
$479.22
|
| Rate for Payer: Quartz Commercial |
$586.80
|
| Rate for Payer: WEA Trust Commercial |
$537.90
|
| Rate for Payer: WPS Commercial |
$724.40
|
|
|
PACK PHACO ADD #DP4310
|
Facility
|
OP
|
$978.00
|
|
| Hospital Charge Code |
2962989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.84 |
| Max. Negotiated Rate |
$3,912.00 |
| Rate for Payer: Aetna Commercial |
$880.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$841.08
|
| Rate for Payer: Aetna Managed Medicare |
$273.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$489.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.34
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna Commercial |
$899.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.29
|
| Rate for Payer: Health EOS Commercial |
$870.42
|
| Rate for Payer: HFN Commercial |
$899.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.50
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: NAPHCARE Commercial |
$586.80
|
| Rate for Payer: Preferred Network Access Commercial |
$899.76
|
| Rate for Payer: Quartz Beloit One Network |
$479.22
|
| Rate for Payer: Quartz Commercial |
$635.70
|
| Rate for Payer: Quartz Medicare Advantage |
$586.80
|
| Rate for Payer: The Alliance Commercial |
$3,912.00
|
| Rate for Payer: WEA Trust Commercial |
$537.90
|
| Rate for Payer: WPS Commercial |
$724.40
|
|
|
PACK SMALL ADULT PUMP X-COATED FX 77039
|
Facility
|
OP
|
$6,658.00
|
|
| Hospital Charge Code |
2962890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,864.24 |
| Max. Negotiated Rate |
$26,632.00 |
| Rate for Payer: Aetna Commercial |
$5,992.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,725.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,864.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,327.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,329.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,195.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,528.74
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,125.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,725.82
|
| Rate for Payer: Health EOS Commercial |
$5,925.62
|
| Rate for Payer: HFN Commercial |
$6,125.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,993.50
|
| Rate for Payer: Multiplan Commercial |
$5,326.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,994.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,125.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,262.42
|
| Rate for Payer: Quartz Commercial |
$4,327.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,994.80
|
| Rate for Payer: The Alliance Commercial |
$26,632.00
|
| Rate for Payer: WEA Trust Commercial |
$3,661.90
|
| Rate for Payer: WPS Commercial |
$4,931.58
|
|
|
PACK SMALL ADULT PUMP X-COATED FX 77039
|
Facility
|
IP
|
$6,658.00
|
|
| Hospital Charge Code |
2962890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,262.42 |
| Max. Negotiated Rate |
$6,125.36 |
| Rate for Payer: Aetna Commercial |
$5,992.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,725.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,528.74
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,125.36
|
| Rate for Payer: Health EOS Commercial |
$5,925.62
|
| Rate for Payer: HFN Commercial |
$6,125.36
|
| Rate for Payer: Multiplan Commercial |
$5,326.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,994.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,125.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,262.42
|
| Rate for Payer: Quartz Commercial |
$3,994.80
|
| Rate for Payer: WEA Trust Commercial |
$3,661.90
|
| Rate for Payer: WPS Commercial |
$4,931.58
|
|
|
PACK STANDARD VASCULAR ACCESS NP AMS15117
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
6206996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.48 |
| Max. Negotiated Rate |
$2,464.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Aetna Managed Medicare |
$172.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$400.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.71
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$462.00
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$400.40
|
| Rate for Payer: Quartz Medicare Advantage |
$369.60
|
| Rate for Payer: The Alliance Commercial |
$2,464.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
PACK STANDARD VASCULAR ACCESS NP AMS15117
|
Facility
|
IP
|
$616.00
|
|
| Hospital Charge Code |
6206996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$369.60
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
PACK VITRECTOMY ANTERIOR INFINITI 8065750157
|
Facility
|
OP
|
$2,729.00
|
|
| Hospital Charge Code |
2962876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$764.12 |
| Max. Negotiated Rate |
$10,916.00 |
| Rate for Payer: Aetna Commercial |
$2,456.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,346.94
|
| Rate for Payer: Aetna Managed Medicare |
$764.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,773.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,364.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,309.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,446.37
|
| Rate for Payer: Cash Price |
$818.70
|
| Rate for Payer: Cigna Commercial |
$2,510.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,527.15
|
| Rate for Payer: Health EOS Commercial |
$2,428.81
|
| Rate for Payer: HFN Commercial |
$2,510.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,046.75
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,637.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,510.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,337.21
|
| Rate for Payer: Quartz Commercial |
$1,773.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,637.40
|
| Rate for Payer: The Alliance Commercial |
$10,916.00
|
| Rate for Payer: WEA Trust Commercial |
$1,500.95
|
| Rate for Payer: WPS Commercial |
$2,021.37
|
|
|
PACK VITRECTOMY ANTERIOR INFINITI 8065750157
|
Facility
|
IP
|
$2,729.00
|
|
| Hospital Charge Code |
2962876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,337.21 |
| Max. Negotiated Rate |
$2,510.68 |
| Rate for Payer: Aetna Commercial |
$2,456.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,346.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,446.37
|
| Rate for Payer: Cash Price |
$818.70
|
| Rate for Payer: Cigna Commercial |
$2,510.68
|
| Rate for Payer: Health EOS Commercial |
$2,428.81
|
| Rate for Payer: HFN Commercial |
$2,510.68
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,637.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,510.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,337.21
|
| Rate for Payer: Quartz Commercial |
$1,637.40
|
| Rate for Payer: WEA Trust Commercial |
$1,500.95
|
| Rate for Payer: WPS Commercial |
$2,021.37
|
|
|
Paclitaxel Injection J9267
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.14
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$0.27
|
|
|
Paclitaxel Injection J9267
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Paclitaxel Injection J9267
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.11
|
| Rate for Payer: Health EOS Commercial |
$10.92
|
| Rate for Payer: HFN Commercial |
$11.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.28
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11.40
|
| Rate for Payer: Quartz Beloit One Network |
$5.28
|
| Rate for Payer: Quartz Commercial |
$6.84
|
| Rate for Payer: The Alliance Commercial |
$6.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.11
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$0.27
|
|
|
PAD ALIGNMENT IMMOBILIZER
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
2963998
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.44 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$41.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$88.80
|
| Rate for Payer: The Alliance Commercial |
$592.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
PAD ALIGNMENT IMMOBILIZER
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
2963998
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
PAD ALVARADO DISPOSABLE LINER 00-1320-015-10
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
6232148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
PAD ALVARADO DISPOSABLE LINER 00-1320-015-10
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
6232148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$79.20
|
| Rate for Payer: The Alliance Commercial |
$528.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
PAD ARMBOARD 2 X 7.5 X 20 M10-323
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
2965828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
PAD ARMBOARD 2 X 7.5 X 20 M10-323
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
2965828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$49.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$106.80
|
| Rate for Payer: The Alliance Commercial |
$712.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
PAD BODY XL PREVALON AIRTAP 7250
|
Facility
|
OP
|
$354.00
|
|
| Hospital Charge Code |
5414959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Aetna Managed Medicare |
$99.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.10
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$265.50
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$230.10
|
| Rate for Payer: Quartz Medicare Advantage |
$212.40
|
| Rate for Payer: The Alliance Commercial |
$1,416.00
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
PAD BODY XL PREVALON AIRTAP 7250
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
5414959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.46 |
| Max. Negotiated Rate |
$325.68 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$212.40
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
PAD CAST DELTA ROLL 3X4 YD
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
2974330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
PAD CAST DELTA ROLL 3X4 YD
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
2974330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.15
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
