|
PACK PHACO ADD #DP4310
|
Facility
|
IP
|
$978.00
|
|
| Hospital Charge Code |
2962989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.39 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$874.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$539.07
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna Commercial |
$935.75
|
| Rate for Payer: Health EOS Commercial |
$905.24
|
| Rate for Payer: HFN Commercial |
$935.75
|
| Rate for Payer: Multiplan Commercial |
$813.70
|
| Rate for Payer: Preferred Network Access Commercial |
$935.75
|
| Rate for Payer: Quartz Beloit One Network |
$498.39
|
| Rate for Payer: Quartz Commercial |
$610.27
|
| Rate for Payer: WEA Trust Commercial |
$559.42
|
| Rate for Payer: WPS Commercial |
$753.35
|
|
|
PACK SMALL ADULT PUMP X-COATED FX 77039
|
Facility
|
IP
|
$6,658.00
|
|
| Hospital Charge Code |
2962890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,392.92 |
| Max. Negotiated Rate |
$6,370.37 |
| Rate for Payer: Aetna Commercial |
$6,231.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,954.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,669.89
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,370.37
|
| Rate for Payer: Health EOS Commercial |
$6,162.64
|
| Rate for Payer: HFN Commercial |
$6,370.37
|
| Rate for Payer: Multiplan Commercial |
$5,539.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,370.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,392.92
|
| Rate for Payer: Quartz Commercial |
$4,154.59
|
| Rate for Payer: WEA Trust Commercial |
$3,808.38
|
| Rate for Payer: WPS Commercial |
$5,128.66
|
|
|
PACK SMALL ADULT PUMP X-COATED FX 77039
|
Facility
|
OP
|
$6,658.00
|
|
| Hospital Charge Code |
2962890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.81 |
| Max. Negotiated Rate |
$6,370.37 |
| Rate for Payer: Aetna Commercial |
$6,231.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,954.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,938.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,500.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,462.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,323.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,669.89
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,370.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,874.96
|
| Rate for Payer: Health EOS Commercial |
$6,162.64
|
| Rate for Payer: HFN Commercial |
$6,370.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,193.24
|
| Rate for Payer: Multiplan Commercial |
$5,539.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,154.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,370.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,392.92
|
| Rate for Payer: Quartz Commercial |
$4,500.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4,154.59
|
| Rate for Payer: The Alliance Commercial |
$3,462.16
|
| Rate for Payer: WEA Trust Commercial |
$3,808.38
|
| Rate for Payer: WPS Commercial |
$5,128.66
|
|
|
PACK STANDARD VASCULAR ACCESS NP AMS15117
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
6206996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$179.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$416.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$320.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.51
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.48
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$416.42
|
| Rate for Payer: Quartz Medicare Advantage |
$384.38
|
| Rate for Payer: The Alliance Commercial |
$320.32
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
PACK STANDARD VASCULAR ACCESS NP AMS15117
|
Facility
|
IP
|
$616.00
|
|
| Hospital Charge Code |
6206996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.91 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$384.38
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
PACK VITRECTOMY ANTERIOR INFINITI 8065750157
|
Facility
|
OP
|
$2,729.00
|
|
| Hospital Charge Code |
2962876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$794.68 |
| Max. Negotiated Rate |
$2,611.11 |
| Rate for Payer: Aetna Commercial |
$2,554.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,440.82
|
| Rate for Payer: Aetna Managed Medicare |
$794.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,844.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,419.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,362.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,504.22
|
| Rate for Payer: Cash Price |
$818.70
|
| Rate for Payer: Cigna Commercial |
$2,611.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,588.28
|
| Rate for Payer: Health EOS Commercial |
$2,525.96
|
| Rate for Payer: HFN Commercial |
$2,611.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,128.62
|
| Rate for Payer: Multiplan Commercial |
$2,270.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,702.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,611.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.70
|
| Rate for Payer: Quartz Commercial |
$1,844.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,702.90
|
| Rate for Payer: The Alliance Commercial |
$1,419.08
|
| Rate for Payer: WEA Trust Commercial |
$1,560.99
|
| Rate for Payer: WPS Commercial |
$2,102.15
|
|
|
PACK VITRECTOMY ANTERIOR INFINITI 8065750157
|
Facility
|
IP
|
$2,729.00
|
|
| Hospital Charge Code |
2962876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,390.70 |
| Max. Negotiated Rate |
$2,611.11 |
| Rate for Payer: Aetna Commercial |
$2,554.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,440.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,504.22
|
| Rate for Payer: Cash Price |
$818.70
|
| Rate for Payer: Cigna Commercial |
$2,611.11
|
| Rate for Payer: Health EOS Commercial |
$2,525.96
|
| Rate for Payer: HFN Commercial |
$2,611.11
|
| Rate for Payer: Multiplan Commercial |
$2,270.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,611.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.70
|
| Rate for Payer: Quartz Commercial |
$1,702.90
|
| Rate for Payer: WEA Trust Commercial |
$1,560.99
|
| Rate for Payer: WPS Commercial |
$2,102.15
|
|
|
Paclitaxel Injection J9267
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$11.86 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$0.11
|
| Rate for Payer: Anthem Medicare Advantage |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.11
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.11
|
| Rate for Payer: Health EOS Commercial |
$11.36
|
| Rate for Payer: HFN Commercial |
$11.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$0.17
|
| Rate for Payer: Preferred Network Access Commercial |
$11.86
|
| Rate for Payer: Quartz Beloit One Network |
$5.49
|
| Rate for Payer: Quartz Commercial |
$7.11
|
| Rate for Payer: Quartz Medicare Advantage |
$0.11
|
| Rate for Payer: The Alliance Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicaid |
$0.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$0.28
|
|
|
Paclitaxel Injection J9267
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.15
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$0.46
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$0.28
|
|
|
Paclitaxel Injection J9267
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
PAD ALIGNMENT IMMOBILIZER
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
2963998
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
PAD ALIGNMENT IMMOBILIZER
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
2963998
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
PAD ALVARADO DISPOSABLE LINER 00-1320-015-10
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
6232148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$38.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$82.37
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$82.37
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
PAD ALVARADO DISPOSABLE LINER 00-1320-015-10
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
6232148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
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 |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
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 |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
PAD BODY XL PREVALON AIRTAP 7250
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
5414959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
PAD BODY XL PREVALON AIRTAP 7250
|
Facility
|
OP
|
$354.00
|
|
| Hospital Charge Code |
5414959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$103.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.03
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.12
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$220.90
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$239.30
|
| Rate for Payer: Quartz Medicare Advantage |
$220.90
|
| Rate for Payer: The Alliance Commercial |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
PAD CAST DELTA ROLL 3X4 YD
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
2974330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
PAD CAST DELTA ROLL 3X4 YD
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
2974330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
PAD CORN POYLMER GEL SOFT 5TH DIGIT
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
2970778
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
PAD CORN POYLMER GEL SOFT 5TH DIGIT
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
2970778
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
PAD DIGITAL MESH SM/MED #A526-002
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2969628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$51.17
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$51.17
|
| Rate for Payer: The Alliance Commercial |
$42.64
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
PAD DIGITAL MESH SM/MED #A526-002
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2969628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
PAD DIGITAL MESH X-SMALL #A526-001
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2971516
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
