|
TAP 4.5MM CANN AR-8956C-45T
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5599721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.50 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
TAP 4.5MM CANN AR-8956C-45T
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5599721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
TAP 5.5MM CANN AR-8956C-55T
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5599722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.50 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
TAP 5.5MM CANN AR-8956C-55T
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5599722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
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 |
$651.41 |
| Max. Negotiated Rate |
$2,140.36 |
| Rate for Payer: Aetna Commercial |
$2,093.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,000.77
|
| Rate for Payer: Aetna Managed Medicare |
$651.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,512.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,163.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,116.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,233.03
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cigna Commercial |
$2,140.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,301.93
|
| Rate for Payer: Health EOS Commercial |
$2,070.57
|
| Rate for Payer: HFN Commercial |
$2,140.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,744.86
|
| Rate for Payer: Multiplan Commercial |
$1,861.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,395.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,140.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,139.98
|
| Rate for Payer: Quartz Commercial |
$1,512.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,395.89
|
| Rate for Payer: The Alliance Commercial |
$1,163.24
|
| Rate for Payer: WEA Trust Commercial |
$1,279.56
|
| Rate for Payer: WPS Commercial |
$1,723.16
|
|
|
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 |
$1,139.98 |
| Max. Negotiated Rate |
$2,140.36 |
| Rate for Payer: Aetna Commercial |
$2,093.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,000.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,233.03
|
| Rate for Payer: Cash Price |
$671.10
|
| Rate for Payer: Cigna Commercial |
$2,140.36
|
| Rate for Payer: Health EOS Commercial |
$2,070.57
|
| Rate for Payer: HFN Commercial |
$2,140.36
|
| Rate for Payer: Multiplan Commercial |
$1,861.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,140.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,139.98
|
| Rate for Payer: Quartz Commercial |
$1,395.89
|
| Rate for Payer: WEA Trust Commercial |
$1,279.56
|
| Rate for Payer: WPS Commercial |
$1,723.16
|
|
|
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 |
$645.01 |
| Max. Negotiated Rate |
$2,119.31 |
| Rate for Payer: Aetna Commercial |
$2,073.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.10
|
| Rate for Payer: Aetna Managed Medicare |
$645.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,497.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.91
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,119.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.13
|
| Rate for Payer: Health EOS Commercial |
$2,050.20
|
| Rate for Payer: HFN Commercial |
$2,119.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.70
|
| Rate for Payer: Multiplan Commercial |
$1,842.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,119.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.76
|
| Rate for Payer: Quartz Commercial |
$1,497.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,382.16
|
| Rate for Payer: The Alliance Commercial |
$1,151.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.98
|
| Rate for Payer: WPS Commercial |
$1,706.21
|
|
|
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 |
$1,128.76 |
| Max. Negotiated Rate |
$2,119.31 |
| Rate for Payer: Aetna Commercial |
$2,073.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.91
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,119.31
|
| Rate for Payer: Health EOS Commercial |
$2,050.20
|
| Rate for Payer: HFN Commercial |
$2,119.31
|
| Rate for Payer: Multiplan Commercial |
$1,842.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,119.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.76
|
| Rate for Payer: Quartz Commercial |
$1,382.16
|
| Rate for Payer: WEA Trust Commercial |
$1,266.98
|
| Rate for Payer: WPS Commercial |
$1,706.21
|
|
|
TAPE BROSELOW
|
Facility
|
IP
|
$573.00
|
|
| Hospital Charge Code |
2963693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$357.55
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
TAPE BROSELOW
|
Facility
|
OP
|
$573.00
|
|
| Hospital Charge Code |
2963693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$166.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.49
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.94
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$357.55
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$387.35
|
| Rate for Payer: Quartz Medicare Advantage |
$357.55
|
| Rate for Payer: The Alliance Commercial |
$297.96
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
TAPE BULK KINESIO ROLL 2 x33.5 #775207
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
2969683
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
TAPE BULK KINESIO ROLL 2 x33.5 #775207
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
2969683
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$280.72 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$280.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.92
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| Rate for Payer: Quartz Medicare Advantage |
$601.54
|
| Rate for Payer: The Alliance Commercial |
$501.28
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
Tape-Dermiclear
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Tape-Dermiclear
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
TAPE E.T. II #11010
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
2973540
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$34.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$74.88
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
TAPE E.T. II #11010
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
2973540
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
TAPE GLOW 'N TELL 55CM 1108-01
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
5178753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
TAPE GLOW 'N TELL 55CM 1108-01
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
5178753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
TAPE KINESIO TEX 3 081605088"
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2971984
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.67 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$103.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$277.68
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$222.14
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$222.14
|
| Rate for Payer: The Alliance Commercial |
$185.12
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
TAPE KINESIO TEX 3 081605088"
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2971984
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
TAPE KINESIO TEX BLUE #0816-05-153
|
Facility
|
OP
|
$1,493.00
|
|
| Hospital Charge Code |
2969869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$434.76 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Aetna Managed Medicare |
$434.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.93
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.54
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: NAPHCARE Commercial |
$931.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$1,009.27
|
| Rate for Payer: Quartz Medicare Advantage |
$931.63
|
| Rate for Payer: The Alliance Commercial |
$776.36
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
TAPE KINESIO TEX BLUE #0816-05-153
|
Facility
|
IP
|
$1,493.00
|
|
| Hospital Charge Code |
2969869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$760.83 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$931.63
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
TAPE KINESIO TEX FP -BLACK 0816-05-179
|
Facility
|
OP
|
$1,493.00
|
|
| Hospital Charge Code |
2969870
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$434.76 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Aetna Managed Medicare |
$434.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.93
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.54
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: NAPHCARE Commercial |
$931.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$1,009.27
|
| Rate for Payer: Quartz Medicare Advantage |
$931.63
|
| Rate for Payer: The Alliance Commercial |
$776.36
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
TAPE KINESIO TEX FP -BLACK 0816-05-179
|
Facility
|
IP
|
$1,493.00
|
|
| Hospital Charge Code |
2969870
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$760.83 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$931.63
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
TAPE MICROFOAM 3 LATEX FREE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
2962792
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$32.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.36
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$69.89
|
| Rate for Payer: The Alliance Commercial |
$58.24
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
