|
PAD GROUNDING CRA-SGP
|
Facility
|
IP
|
$213.00
|
|
| Hospital Charge Code |
4595346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
PAD GROUNDING CRA-SGP
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
4595346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$62.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.14
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$132.91
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$132.91
|
| Rate for Payer: The Alliance Commercial |
$110.76
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
PAD GROUNDING POLYHESIVE E7507
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
PAD GROUNDING POLYHESIVE E7507
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
PAD HEEL AND LACE #5510-66
|
Facility
|
OP
|
$398.00
|
|
| Hospital Charge Code |
2974055
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$115.90 |
| Max. Negotiated Rate |
$380.81 |
| Rate for Payer: Aetna Commercial |
$372.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Aetna Managed Medicare |
$115.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.38
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$380.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.64
|
| Rate for Payer: Health EOS Commercial |
$368.39
|
| Rate for Payer: HFN Commercial |
$380.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.44
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: NAPHCARE Commercial |
$248.35
|
| Rate for Payer: Preferred Network Access Commercial |
$380.81
|
| Rate for Payer: Quartz Beloit One Network |
$202.82
|
| Rate for Payer: Quartz Commercial |
$269.05
|
| Rate for Payer: Quartz Medicare Advantage |
$248.35
|
| Rate for Payer: The Alliance Commercial |
$206.96
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: WPS Commercial |
$306.58
|
|
|
PAD HEEL AND LACE #5510-66
|
Facility
|
IP
|
$398.00
|
|
| Hospital Charge Code |
2974055
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$380.81 |
| Rate for Payer: Aetna Commercial |
$372.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.38
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$380.81
|
| Rate for Payer: Health EOS Commercial |
$368.39
|
| Rate for Payer: HFN Commercial |
$380.81
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: Preferred Network Access Commercial |
$380.81
|
| Rate for Payer: Quartz Beloit One Network |
$202.82
|
| Rate for Payer: Quartz Commercial |
$248.35
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: WPS Commercial |
$306.58
|
|
|
PAD KNEE POSITIONING TRIANGLE 193-P
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2965164
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
PAD KNEE POSITIONING TRIANGLE 193-P
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2965164
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
PAD LEG HOLDER BLUE INSERT 10223B
|
Facility
|
IP
|
$499.00
|
|
| Hospital Charge Code |
2965287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
PAD LEG HOLDER BLUE INSERT 10223B
|
Facility
|
OP
|
$499.00
|
|
| Hospital Charge Code |
2965287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$145.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.42
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.22
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$311.38
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$337.32
|
| Rate for Payer: Quartz Medicare Advantage |
$311.38
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
PAD LEG PLATE ATTACHMENT
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
2963726
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
PAD LEG PLATE ATTACHMENT
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
2963726
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
PAD LEVEL SENSOR II 195240
|
Facility
|
OP
|
$168.00
|
|
| Hospital Charge Code |
2965159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
PAD LEVEL SENSOR II 195240
|
Facility
|
IP
|
$168.00
|
|
| Hospital Charge Code |
2965159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
PAD MASIMO TRANSFLECTANCE SENSOR 1903
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2974424
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24.96
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
PAD MASIMO TRANSFLECTANCE SENSOR 1903
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2974424
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
PAD NURSING 2630
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
2963742
|
|
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
|
|
|
PAD NURSING 2630
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
2963742
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| 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: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
PAD OVAL EYE
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
2964014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
PAD OVAL EYE
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
2964014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
PAD PERINEAL POST OSI 6855-13
|
Facility
|
OP
|
$198.00
|
|
| Hospital Charge Code |
3907338
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.66 |
| Max. Negotiated Rate |
$189.45 |
| Rate for Payer: Aetna Commercial |
$185.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.09
|
| Rate for Payer: Aetna Managed Medicare |
$57.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.14
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$189.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.24
|
| Rate for Payer: Health EOS Commercial |
$183.27
|
| Rate for Payer: HFN Commercial |
$189.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.44
|
| Rate for Payer: Multiplan Commercial |
$164.74
|
| Rate for Payer: NAPHCARE Commercial |
$123.55
|
| Rate for Payer: Preferred Network Access Commercial |
$189.45
|
| Rate for Payer: Quartz Beloit One Network |
$100.90
|
| Rate for Payer: Quartz Commercial |
$133.85
|
| Rate for Payer: Quartz Medicare Advantage |
$123.55
|
| Rate for Payer: The Alliance Commercial |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$113.26
|
| Rate for Payer: WPS Commercial |
$152.52
|
|
|
PAD PERINEAL POST OSI 6855-13
|
Facility
|
IP
|
$198.00
|
|
| Hospital Charge Code |
3907338
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.90 |
| Max. Negotiated Rate |
$189.45 |
| Rate for Payer: Aetna Commercial |
$185.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.14
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$189.45
|
| Rate for Payer: Health EOS Commercial |
$183.27
|
| Rate for Payer: HFN Commercial |
$189.45
|
| Rate for Payer: Multiplan Commercial |
$164.74
|
| Rate for Payer: Preferred Network Access Commercial |
$189.45
|
| Rate for Payer: Quartz Beloit One Network |
$100.90
|
| Rate for Payer: Quartz Commercial |
$123.55
|
| Rate for Payer: WEA Trust Commercial |
$113.26
|
| Rate for Payer: WPS Commercial |
$152.52
|
|
|
PAD PERINEAL SUPINE S & N 72200634
|
Facility
|
OP
|
$1,510.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5286796
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$439.71 |
| Max. Negotiated Rate |
$1,444.77 |
| Rate for Payer: Aetna Commercial |
$1,413.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.54
|
| Rate for Payer: Aetna Managed Medicare |
$439.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,020.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$753.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.31
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$1,444.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$878.82
|
| Rate for Payer: Health EOS Commercial |
$1,397.66
|
| Rate for Payer: HFN Commercial |
$1,444.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,177.80
|
| Rate for Payer: Multiplan Commercial |
$1,256.32
|
| Rate for Payer: NAPHCARE Commercial |
$942.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.77
|
| Rate for Payer: Quartz Beloit One Network |
$769.50
|
| Rate for Payer: Quartz Commercial |
$1,020.76
|
| Rate for Payer: Quartz Medicare Advantage |
$942.24
|
| Rate for Payer: The Alliance Commercial |
$785.20
|
| Rate for Payer: WEA Trust Commercial |
$863.72
|
| Rate for Payer: WPS Commercial |
$1,163.15
|
|
|
PAD PERINEAL SUPINE S & N 72200634
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5286796
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$1,444.77 |
| Rate for Payer: Aetna Commercial |
$1,413.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.31
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$1,444.77
|
| Rate for Payer: Health EOS Commercial |
$1,397.66
|
| Rate for Payer: HFN Commercial |
$1,444.77
|
| Rate for Payer: Multiplan Commercial |
$1,256.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.77
|
| Rate for Payer: Quartz Beloit One Network |
$769.50
|
| Rate for Payer: Quartz Commercial |
$942.24
|
| Rate for Payer: WEA Trust Commercial |
$863.72
|
| Rate for Payer: WPS Commercial |
$1,163.15
|
|
|
PAD SENSA T.R.A.C. (TUBING CLAMP & CONNECTOR) M8275057/10
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS A6550
|
| Hospital Charge Code |
4020640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$132.79
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
