|
TALON 3 PRONG 2.4/120 M0063701110
|
Facility
|
OP
|
$2,544.00
|
|
| Hospital Charge Code |
4520076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.32 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$2,289.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,187.84
|
| Rate for Payer: Aetna Managed Medicare |
$712.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,653.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,221.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,348.32
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,340.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,423.62
|
| Rate for Payer: Health EOS Commercial |
$2,264.16
|
| Rate for Payer: HFN Commercial |
$2,340.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,908.00
|
| Rate for Payer: Multiplan Commercial |
$2,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,246.56
|
| Rate for Payer: Quartz Commercial |
$1,653.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,526.40
|
| Rate for Payer: The Alliance Commercial |
$10,176.00
|
| Rate for Payer: WEA Trust Commercial |
$1,399.20
|
| Rate for Payer: WPS Commercial |
$1,884.34
|
|
|
TALON 3 PRONG 2.4/120 M0063701110
|
Facility
|
IP
|
$2,544.00
|
|
| Hospital Charge Code |
4520076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.56 |
| Max. Negotiated Rate |
$2,340.48 |
| Rate for Payer: Aetna Commercial |
$2,289.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,187.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,348.32
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,340.48
|
| Rate for Payer: Health EOS Commercial |
$2,264.16
|
| Rate for Payer: HFN Commercial |
$2,340.48
|
| Rate for Payer: Multiplan Commercial |
$2,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,246.56
|
| Rate for Payer: Quartz Commercial |
$1,526.40
|
| Rate for Payer: WEA Trust Commercial |
$1,399.20
|
| Rate for Payer: WPS Commercial |
$1,884.34
|
|
|
T and B Cells, Total
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4524606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
T and B Cells, Total
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4524606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$150.92 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
T and B Cells, Total
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4524606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$133.19 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Tangential Biopsy Skin Ea Sep/Add Lesion 11103
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
5454806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$117.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.40
|
| Rate for Payer: Health EOS Commercial |
$112.84
|
| Rate for Payer: HFN Commercial |
$117.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.78
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Preferred Network Access Commercial |
$117.80
|
| Rate for Payer: Quartz Beloit One Network |
$54.56
|
| Rate for Payer: Quartz Commercial |
$70.68
|
| Rate for Payer: The Alliance Commercial |
$62.00
|
| Rate for Payer: United Healthcare Medicaid |
$41.27
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Tangential Biopsy Skin Single Lesion 11102
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
5454807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.00
|
| Rate for Payer: Health EOS Commercial |
$364.00
|
| Rate for Payer: HFN Commercial |
$380.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.22
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Preferred Network Access Commercial |
$380.00
|
| Rate for Payer: Quartz Beloit One Network |
$176.00
|
| Rate for Payer: Quartz Commercial |
$228.00
|
| Rate for Payer: The Alliance Commercial |
$200.00
|
| Rate for Payer: United Healthcare Medicaid |
$76.51
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: WPS Commercial |
$296.28
|
|
|
TAP 4.5MM CANN AR-8956C-45T
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5599721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
TAP 4.5MM CANN AR-8956C-45T
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5599721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
TAP 5.5MM CANN AR-8956C-55T
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5599722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
TAP 5.5MM CANN AR-8956C-55T
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5599722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
TAP BIO-COMPOSITE SCREW CANN DILATOR 20MM AR-5025TBC
|
Facility
|
OP
|
$2,237.00
|
|
| Hospital Charge Code |
6220122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.36 |
| Max. Negotiated Rate |
$8,948.00 |
| Rate for Payer: Aetna Commercial |
$2,013.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,923.82
|
| Rate for Payer: Aetna Managed Medicare |
$626.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,454.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,118.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,073.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,185.61
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cigna Commercial |
$2,058.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,251.83
|
| Rate for Payer: Health EOS Commercial |
$1,990.93
|
| Rate for Payer: HFN Commercial |
$2,058.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,677.75
|
| Rate for Payer: Multiplan Commercial |
$1,789.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,342.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,058.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.13
|
| Rate for Payer: Quartz Commercial |
$1,454.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,342.20
|
| Rate for Payer: The Alliance Commercial |
$8,948.00
|
| Rate for Payer: WEA Trust Commercial |
$1,230.35
|
| Rate for Payer: WPS Commercial |
$1,656.95
|
|
|
TAP BIO-COMPOSITE SCREW CANN DILATOR 20MM AR-5025TBC
|
Facility
|
IP
|
$2,237.00
|
|
| Hospital Charge Code |
6220122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,096.13 |
| Max. Negotiated Rate |
$2,058.04 |
| Rate for Payer: Aetna Commercial |
$2,013.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,923.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,185.61
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cigna Commercial |
$2,058.04
|
| Rate for Payer: Health EOS Commercial |
$1,990.93
|
| Rate for Payer: HFN Commercial |
$2,058.04
|
| Rate for Payer: Multiplan Commercial |
$1,789.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,342.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,058.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.13
|
| Rate for Payer: Quartz Commercial |
$1,342.20
|
| Rate for Payer: WEA Trust Commercial |
$1,230.35
|
| Rate for Payer: WPS Commercial |
$1,656.95
|
|
|
TAP BIO-COMPOSITE SCREW CANN DILATOR 22MM AR-5025TBC-22
|
Facility
|
OP
|
$2,215.00
|
|
| Hospital Charge Code |
6177772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.20 |
| Max. Negotiated Rate |
$8,860.00 |
| Rate for Payer: Aetna Commercial |
$1,993.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.90
|
| Rate for Payer: Aetna Managed Medicare |
$620.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.95
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,037.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,239.51
|
| Rate for Payer: Health EOS Commercial |
$1,971.35
|
| Rate for Payer: HFN Commercial |
$2,037.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,661.25
|
| Rate for Payer: Multiplan Commercial |
$1,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.35
|
| Rate for Payer: Quartz Commercial |
$1,439.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.00
|
| Rate for Payer: The Alliance Commercial |
$8,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.25
|
| Rate for Payer: WPS Commercial |
$1,640.65
|
|
|
TAP BIO-COMPOSITE SCREW CANN DILATOR 22MM AR-5025TBC-22
|
Facility
|
IP
|
$2,215.00
|
|
| Hospital Charge Code |
6177772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,085.35 |
| Max. Negotiated Rate |
$2,037.80 |
| Rate for Payer: Aetna Commercial |
$1,993.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.95
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,037.80
|
| Rate for Payer: Health EOS Commercial |
$1,971.35
|
| Rate for Payer: HFN Commercial |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$1,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.35
|
| Rate for Payer: Quartz Commercial |
$1,329.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.25
|
| Rate for Payer: WPS Commercial |
$1,640.65
|
|
|
TAPE BROSELOW
|
Facility
|
IP
|
$573.00
|
|
| Hospital Charge Code |
2963693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$280.77 |
| Max. Negotiated Rate |
$527.16 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$343.80
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
TAPE BROSELOW
|
Facility
|
OP
|
$573.00
|
|
| Hospital Charge Code |
2963693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.44 |
| Max. Negotiated Rate |
$2,292.00 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$160.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.65
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.75
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$372.45
|
| Rate for Payer: Quartz Medicare Advantage |
$343.80
|
| Rate for Payer: The Alliance Commercial |
$2,292.00
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
TAPE BULK KINESIO ROLL 2 x33.5 #775207
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
2969683
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$269.92 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Aetna Managed Medicare |
$269.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$626.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$482.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.45
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.00
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$626.60
|
| Rate for Payer: Quartz Medicare Advantage |
$578.40
|
| Rate for Payer: The Alliance Commercial |
$3,856.00
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
TAPE BULK KINESIO ROLL 2 x33.5 #775207
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
2969683
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$472.36 |
| Max. Negotiated Rate |
$886.88 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$578.40
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
Tape-Dermiclear
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Tape-Dermiclear
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
TAPE E.T. II #11010
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
2973540
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$72.00
|
| Rate for Payer: The Alliance Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
TAPE E.T. II #11010
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
2973540
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
TAPE GLOW 'N TELL 55CM 1108-01
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
5178753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.64 |
| Max. Negotiated Rate |
$1,413.12 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$921.60
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
TAPE GLOW 'N TELL 55CM 1108-01
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
5178753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$6,144.00 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Aetna Managed Medicare |
$430.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$998.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.55
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: Quartz Medicare Advantage |
$921.60
|
| Rate for Payer: The Alliance Commercial |
$6,144.00
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
