|
PCR DNA Marker G2722C
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$96.10
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker G2722C
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.63
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.12
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$96.10
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$104.10
|
| Rate for Payer: Quartz Medicare Advantage |
$96.10
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: United Healthcare PPO |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
Peak Plasma Blade
|
Facility
|
OP
|
$3,472.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,011.05 |
| Max. Negotiated Rate |
$3,322.01 |
| Rate for Payer: Aetna Commercial |
$3,249.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,105.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,011.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,347.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,805.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,733.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,913.77
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$3,322.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,020.70
|
| Rate for Payer: Health EOS Commercial |
$3,213.68
|
| Rate for Payer: HFN Commercial |
$3,322.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,708.16
|
| Rate for Payer: Multiplan Commercial |
$2,888.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,166.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,322.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,769.33
|
| Rate for Payer: Quartz Commercial |
$2,347.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,166.53
|
| Rate for Payer: The Alliance Commercial |
$1,805.44
|
| Rate for Payer: WEA Trust Commercial |
$1,985.98
|
| Rate for Payer: WPS Commercial |
$2,674.48
|
|
|
Peak Plasma Blade
|
Facility
|
IP
|
$3,472.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,769.33 |
| Max. Negotiated Rate |
$3,322.01 |
| Rate for Payer: Aetna Commercial |
$3,249.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,105.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,913.77
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$3,322.01
|
| Rate for Payer: Health EOS Commercial |
$3,213.68
|
| Rate for Payer: HFN Commercial |
$3,322.01
|
| Rate for Payer: Multiplan Commercial |
$2,888.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,322.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,769.33
|
| Rate for Payer: Quartz Commercial |
$2,166.53
|
| Rate for Payer: WEA Trust Commercial |
$1,985.98
|
| Rate for Payer: WPS Commercial |
$2,674.48
|
|
|
Pedal Access Kit
|
Facility
|
OP
|
$789.00
|
|
| Hospital Charge Code |
4534608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.76 |
| Max. Negotiated Rate |
$754.92 |
| Rate for Payer: Aetna Commercial |
$738.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$705.68
|
| Rate for Payer: Aetna Managed Medicare |
$229.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$533.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$393.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$434.90
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$754.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.20
|
| Rate for Payer: Health EOS Commercial |
$730.30
|
| Rate for Payer: HFN Commercial |
$754.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.42
|
| Rate for Payer: Multiplan Commercial |
$656.45
|
| Rate for Payer: NAPHCARE Commercial |
$492.34
|
| Rate for Payer: Preferred Network Access Commercial |
$754.92
|
| Rate for Payer: Quartz Beloit One Network |
$402.07
|
| Rate for Payer: Quartz Commercial |
$533.36
|
| Rate for Payer: Quartz Medicare Advantage |
$492.34
|
| Rate for Payer: The Alliance Commercial |
$410.28
|
| Rate for Payer: WEA Trust Commercial |
$451.31
|
| Rate for Payer: WPS Commercial |
$607.77
|
|
|
Pedal Access Kit
|
Facility
|
IP
|
$789.00
|
|
| Hospital Charge Code |
4534608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.07 |
| Max. Negotiated Rate |
$754.92 |
| Rate for Payer: Aetna Commercial |
$738.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$705.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$434.90
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$754.92
|
| Rate for Payer: Health EOS Commercial |
$730.30
|
| Rate for Payer: HFN Commercial |
$754.92
|
| Rate for Payer: Multiplan Commercial |
$656.45
|
| Rate for Payer: Preferred Network Access Commercial |
$754.92
|
| Rate for Payer: Quartz Beloit One Network |
$402.07
|
| Rate for Payer: Quartz Commercial |
$492.34
|
| Rate for Payer: WEA Trust Commercial |
$451.31
|
| Rate for Payer: WPS Commercial |
$607.77
|
|
|
PED Breathing Unit
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
3101732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
PED Breathing Unit
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
3101732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
Ped Combo Pad
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
3040334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$16.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.90
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$34.32
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$34.32
|
| Rate for Payer: The Alliance Commercial |
$28.60
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Ped Combo Pad
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
3040334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Pediasure
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS B4160
|
| Hospital Charge Code |
3031448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Pediasure
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS B4160
|
| Hospital Charge Code |
3031448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Pediatric airway stabilization collar - Endotracheal Tube Status
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS L0174
|
| Hospital Charge Code |
3025910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.38 |
| Max. Negotiated Rate |
$1,423.72 |
| Rate for Payer: Aetna Commercial |
$1,208.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.67
|
| Rate for Payer: Aetna Managed Medicare |
$375.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.60
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.36
|
| Rate for Payer: Health EOS Commercial |
$1,194.95
|
| Rate for Payer: HFN Commercial |
$1,235.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,006.98
|
| Rate for Payer: Multiplan Commercial |
$1,074.11
|
| Rate for Payer: NAPHCARE Commercial |
$805.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.23
|
| Rate for Payer: Quartz Beloit One Network |
$657.89
|
| Rate for Payer: Quartz Commercial |
$872.72
|
| Rate for Payer: Quartz Medicare Advantage |
$805.58
|
| Rate for Payer: The Alliance Commercial |
$1,423.72
|
| Rate for Payer: WEA Trust Commercial |
$738.45
|
| Rate for Payer: WPS Commercial |
$994.46
|
|
|
Pediatric airway stabilization collar - Endotracheal Tube Status
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS L0174
|
| Hospital Charge Code |
3025910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$657.89 |
| Max. Negotiated Rate |
$1,235.23 |
| Rate for Payer: Aetna Commercial |
$1,208.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.60
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: Health EOS Commercial |
$1,194.95
|
| Rate for Payer: HFN Commercial |
$1,235.23
|
| Rate for Payer: Multiplan Commercial |
$1,074.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.23
|
| Rate for Payer: Quartz Beloit One Network |
$657.89
|
| Rate for Payer: Quartz Commercial |
$805.58
|
| Rate for Payer: WEA Trust Commercial |
$738.45
|
| Rate for Payer: WPS Commercial |
$994.46
|
|
|
Pediatric Cannuals
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040336
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Pediatric Cannuals
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040336
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Pediatric Ezio
|
Facility
|
IP
|
$231.00
|
|
| Hospital Charge Code |
3040372
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Pediatric Ezio
|
Facility
|
OP
|
$231.00
|
|
| Hospital Charge Code |
3040372
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$67.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$144.14
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
PEDIFIX ARCH BINDER LARGE
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2969827
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
PEDIFIX ARCH BINDER LARGE
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2969827
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
PEDIFIX ARCH BINDER MEDIUM
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2969828
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
PEDIFIX ARCH BINDER MEDIUM
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2969828
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
PEDI-PAD ADHESIVE FOAM SZ 104 9204
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
2970945
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
PEDI-PAD ADHESIVE FOAM SZ 104 9204
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
2970945
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
PEDI PAD MOLESKIN 101-A
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
2970599
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
