|
PROSTHESIS VOICE INDWELLING 20fr 8mm #IN 2008-IR
|
Facility
|
OP
|
$2,780.00
|
|
| Hospital Charge Code |
2973255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.40 |
| Max. Negotiated Rate |
$11,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,390.80
|
| Rate for Payer: Aetna Managed Medicare |
$778.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.40
|
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$2,557.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,555.69
|
| Rate for Payer: Health EOS Commercial |
$2,474.20
|
| Rate for Payer: HFN Commercial |
$2,557.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.00
|
| Rate for Payer: Multiplan Commercial |
$2,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,557.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.20
|
| Rate for Payer: Quartz Commercial |
$1,807.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.00
|
| Rate for Payer: The Alliance Commercial |
$11,120.00
|
| Rate for Payer: WEA Trust Commercial |
$1,529.00
|
| Rate for Payer: WPS Commercial |
$2,059.15
|
|
|
PROSTHESIS VOICE INDWELLING 20FR 8mm #IN 2008-NS
|
Facility
|
IP
|
$2,869.00
|
|
| Hospital Charge Code |
2973135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.81 |
| Max. Negotiated Rate |
$2,639.48 |
| Rate for Payer: Aetna Commercial |
$2,582.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,467.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.57
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,639.48
|
| Rate for Payer: Health EOS Commercial |
$2,553.41
|
| Rate for Payer: HFN Commercial |
$2,639.48
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,721.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.81
|
| Rate for Payer: Quartz Commercial |
$1,721.40
|
| Rate for Payer: WEA Trust Commercial |
$1,577.95
|
| Rate for Payer: WPS Commercial |
$2,125.07
|
|
|
PROSTHESIS VOICE INDWELLING 20FR 8mm #IN 2008-NS
|
Facility
|
OP
|
$2,869.00
|
|
| Hospital Charge Code |
2973135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.32 |
| Max. Negotiated Rate |
$11,476.00 |
| Rate for Payer: Aetna Commercial |
$2,582.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,467.34
|
| Rate for Payer: Aetna Managed Medicare |
$803.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.57
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,639.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,605.49
|
| Rate for Payer: Health EOS Commercial |
$2,553.41
|
| Rate for Payer: HFN Commercial |
$2,639.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,151.75
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,721.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.81
|
| Rate for Payer: Quartz Commercial |
$1,864.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,721.40
|
| Rate for Payer: The Alliance Commercial |
$11,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.95
|
| Rate for Payer: WPS Commercial |
$2,125.07
|
|
|
Protamine Sulfate 50mg/5ml vial [Med]
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
2974976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.81
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$5.32
|
|
|
Protamine Sulfate 50mg/5ml vial [Med]
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
2974976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
PROTECTIVE TIP CAP 3MM BROWN 5047-1-030
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
6165644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$120.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.50
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$258.00
|
| Rate for Payer: The Alliance Commercial |
$1,720.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
PROTECTIVE TIP CAP 3MM BROWN 5047-1-030
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
6165644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
PROTECTOR ELBOW LRG W/GEL
|
Facility
|
IP
|
$681.00
|
|
| Hospital Charge Code |
2971537
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$333.69 |
| Max. Negotiated Rate |
$626.52 |
| Rate for Payer: Aetna Commercial |
$612.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.93
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$626.52
|
| Rate for Payer: Health EOS Commercial |
$606.09
|
| Rate for Payer: HFN Commercial |
$626.52
|
| Rate for Payer: Multiplan Commercial |
$544.80
|
| Rate for Payer: NAPHCARE Commercial |
$408.60
|
| Rate for Payer: Preferred Network Access Commercial |
$626.52
|
| Rate for Payer: Quartz Beloit One Network |
$333.69
|
| Rate for Payer: Quartz Commercial |
$408.60
|
| Rate for Payer: WEA Trust Commercial |
$374.55
|
| Rate for Payer: WPS Commercial |
$504.42
|
|
|
PROTECTOR ELBOW LRG W/GEL
|
Facility
|
OP
|
$681.00
|
|
| Hospital Charge Code |
2971537
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$190.68 |
| Max. Negotiated Rate |
$2,724.00 |
| Rate for Payer: Aetna Commercial |
$612.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.66
|
| Rate for Payer: Aetna Managed Medicare |
$190.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.93
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$626.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.09
|
| Rate for Payer: Health EOS Commercial |
$606.09
|
| Rate for Payer: HFN Commercial |
$626.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.75
|
| Rate for Payer: Multiplan Commercial |
$544.80
|
| Rate for Payer: NAPHCARE Commercial |
$408.60
|
| Rate for Payer: Preferred Network Access Commercial |
$626.52
|
| Rate for Payer: Quartz Beloit One Network |
$333.69
|
| Rate for Payer: Quartz Commercial |
$442.65
|
| Rate for Payer: Quartz Medicare Advantage |
$408.60
|
| Rate for Payer: The Alliance Commercial |
$2,724.00
|
| Rate for Payer: WEA Trust Commercial |
$374.55
|
| Rate for Payer: WPS Commercial |
$504.42
|
|
|
PROTECTOR ELBOW X-LRG W/GEL
|
Facility
|
IP
|
$681.00
|
|
| Hospital Charge Code |
2971538
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$333.69 |
| Max. Negotiated Rate |
$626.52 |
| Rate for Payer: Aetna Commercial |
$612.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.93
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$626.52
|
| Rate for Payer: Health EOS Commercial |
$606.09
|
| Rate for Payer: HFN Commercial |
$626.52
|
| Rate for Payer: Multiplan Commercial |
$544.80
|
| Rate for Payer: NAPHCARE Commercial |
$408.60
|
| Rate for Payer: Preferred Network Access Commercial |
$626.52
|
| Rate for Payer: Quartz Beloit One Network |
$333.69
|
| Rate for Payer: Quartz Commercial |
$408.60
|
| Rate for Payer: WEA Trust Commercial |
$374.55
|
| Rate for Payer: WPS Commercial |
$504.42
|
|
|
PROTECTOR ELBOW X-LRG W/GEL
|
Facility
|
OP
|
$681.00
|
|
| Hospital Charge Code |
2971538
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$190.68 |
| Max. Negotiated Rate |
$2,724.00 |
| Rate for Payer: Aetna Commercial |
$612.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.66
|
| Rate for Payer: Aetna Managed Medicare |
$190.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.93
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$626.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.09
|
| Rate for Payer: Health EOS Commercial |
$606.09
|
| Rate for Payer: HFN Commercial |
$626.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.75
|
| Rate for Payer: Multiplan Commercial |
$544.80
|
| Rate for Payer: NAPHCARE Commercial |
$408.60
|
| Rate for Payer: Preferred Network Access Commercial |
$626.52
|
| Rate for Payer: Quartz Beloit One Network |
$333.69
|
| Rate for Payer: Quartz Commercial |
$442.65
|
| Rate for Payer: Quartz Medicare Advantage |
$408.60
|
| Rate for Payer: The Alliance Commercial |
$2,724.00
|
| Rate for Payer: WEA Trust Commercial |
$374.55
|
| Rate for Payer: WPS Commercial |
$504.42
|
|
|
PROTECTOR EYE OPTI-GARD STERIL #28310
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
2972743
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
PROTECTOR EYE OPTI-GARD STERIL #28310
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
2972743
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$96.00
|
| Rate for Payer: The Alliance Commercial |
$640.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
PROTECTOR HEELBO LARGE #7000-03
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
2969612
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
PROTECTOR HEELBO LARGE #7000-03
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
2969612
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$71.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.26
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: The Alliance Commercial |
$1,024.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
PROTECTOR HEELBO X-LARGE #081181742
|
Facility
|
OP
|
$241.00
|
|
| Hospital Charge Code |
2969613
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$67.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.86
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$156.65
|
| Rate for Payer: Quartz Medicare Advantage |
$144.60
|
| Rate for Payer: The Alliance Commercial |
$964.00
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
PROTECTOR HEELBO X-LARGE #081181742
|
Facility
|
IP
|
$241.00
|
|
| Hospital Charge Code |
2969613
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$144.60
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
PROTECTOR HEELBO XXL-BEIGE 081181759
|
Facility
|
IP
|
$241.00
|
|
| Hospital Charge Code |
2969654
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$144.60
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
PROTECTOR HEELBO XXL-BEIGE 081181759
|
Facility
|
OP
|
$241.00
|
|
| Hospital Charge Code |
2969654
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$67.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.86
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$156.65
|
| Rate for Payer: Quartz Medicare Advantage |
$144.60
|
| Rate for Payer: The Alliance Commercial |
$964.00
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
PROTECTOR HEEL/ELBOW SMALL
|
Facility
|
OP
|
$241.00
|
|
| Hospital Charge Code |
2970733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$67.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.86
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$156.65
|
| Rate for Payer: Quartz Medicare Advantage |
$144.60
|
| Rate for Payer: The Alliance Commercial |
$964.00
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
PROTECTOR HEEL/ELBOW SMALL
|
Facility
|
IP
|
$241.00
|
|
| Hospital Charge Code |
2970733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$144.60
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Protector heel or elbow E0191
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS E0191
|
| Hospital Charge Code |
4036669
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$6.60
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Protector heel or elbow E0191
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS E0191
|
| Hospital Charge Code |
4036669
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Managed Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.16
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$7.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.60
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Protector heel or elbow E0191
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS E0191
|
| Hospital Charge Code |
4036669
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.60
|
| Rate for Payer: Health EOS Commercial |
$10.01
|
| Rate for Payer: HFN Commercial |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10.45
|
| Rate for Payer: Quartz Beloit One Network |
$4.84
|
| Rate for Payer: Quartz Commercial |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$5.50
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
PROTECTOR TEETH ADULT #9-3041-03
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2974706
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.40
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
