|
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-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
|
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 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 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
|
|
|
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 KINESIO TEX 3 081605088"
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2971984
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
TAPE KINESIO TEX 3 081605088"
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2971984
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
TAPE KINESIO TEX BLUE #0816-05-153
|
Facility
|
IP
|
$1,493.00
|
|
| Hospital Charge Code |
2969869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$731.57 |
| Max. Negotiated Rate |
$1,373.56 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$895.80
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
TAPE KINESIO TEX BLUE #0816-05-153
|
Facility
|
OP
|
$1,493.00
|
|
| Hospital Charge Code |
2969869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$418.04 |
| Max. Negotiated Rate |
$5,972.00 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$418.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.48
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.75
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$970.45
|
| Rate for Payer: Quartz Medicare Advantage |
$895.80
|
| Rate for Payer: The Alliance Commercial |
$5,972.00
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
TAPE KINESIO TEX FP -BLACK 0816-05-179
|
Facility
|
IP
|
$1,493.00
|
|
| Hospital Charge Code |
2969870
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$731.57 |
| Max. Negotiated Rate |
$1,373.56 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$895.80
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
TAPE KINESIO TEX FP -BLACK 0816-05-179
|
Facility
|
OP
|
$1,493.00
|
|
| Hospital Charge Code |
2969870
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$418.04 |
| Max. Negotiated Rate |
$5,972.00 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$418.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.48
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.75
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$970.45
|
| Rate for Payer: Quartz Medicare Advantage |
$895.80
|
| Rate for Payer: The Alliance Commercial |
$5,972.00
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
TAPE MICROFOAM 3 LATEX FREE
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
2962792
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$67.20
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
TAPE MICROFOAM 3 LATEX FREE
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
2962792
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$31.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$72.80
|
| Rate for Payer: Quartz Medicare Advantage |
$67.20
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Tapentadol, Quant, Urine
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
4618955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Tapentadol, Quant, Urine
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
4618955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.44 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Tapentadol, Quant, Urine
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
4618955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
TAPER ADAPTER BIOLOX +6 650-1068
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$7,012.00 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Aetna Managed Medicare |
$490.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.98
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.75
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,139.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.80
|
| Rate for Payer: The Alliance Commercial |
$7,012.00
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
TAPER ADAPTER BIOLOX +6 650-1068
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.97 |
| Max. Negotiated Rate |
$1,612.76 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,051.80
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
TAPE RETRACT-O-TAPE VASCULAR LOOPS 12X X 18G 1041"
|
Facility
|
IP
|
$456.00
|
|
| Hospital Charge Code |
4998636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$419.52
|
| Rate for Payer: Health EOS Commercial |
$405.84
|
| Rate for Payer: HFN Commercial |
$419.52
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: NAPHCARE Commercial |
$273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.52
|
| Rate for Payer: Quartz Beloit One Network |
$223.44
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
TAPE RETRACT-O-TAPE VASCULAR LOOPS 12X X 18G 1041"
|
Facility
|
OP
|
$456.00
|
|
| Hospital Charge Code |
4998636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.16
|
| Rate for Payer: Aetna Managed Medicare |
$127.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$419.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.18
|
| Rate for Payer: Health EOS Commercial |
$405.84
|
| Rate for Payer: HFN Commercial |
$419.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: NAPHCARE Commercial |
$273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.52
|
| Rate for Payer: Quartz Beloit One Network |
$223.44
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: Quartz Medicare Advantage |
$273.60
|
| Rate for Payer: The Alliance Commercial |
$1,824.00
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
TAPER PLUG NEXGEN 00-5960-099-00
|
Facility
|
OP
|
$4,711.00
|
|
| Hospital Charge Code |
3269464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.08 |
| Max. Negotiated Rate |
$18,844.00 |
| Rate for Payer: Aetna Commercial |
$4,239.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,319.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,062.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,355.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,261.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,496.83
|
| Rate for Payer: Cash Price |
$1,413.30
|
| Rate for Payer: Cigna Commercial |
$4,334.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,636.28
|
| Rate for Payer: Health EOS Commercial |
$4,192.79
|
| Rate for Payer: HFN Commercial |
$4,334.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,533.25
|
| Rate for Payer: Multiplan Commercial |
$3,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,826.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.39
|
| Rate for Payer: Quartz Commercial |
$3,062.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,826.60
|
| Rate for Payer: The Alliance Commercial |
$18,844.00
|
| Rate for Payer: WEA Trust Commercial |
$2,591.05
|
| Rate for Payer: WPS Commercial |
$3,489.44
|
|
|
TAPER PLUG NEXGEN 00-5960-099-00
|
Facility
|
IP
|
$4,711.00
|
|
| Hospital Charge Code |
3269464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,308.39 |
| Max. Negotiated Rate |
$4,334.12 |
| Rate for Payer: Aetna Commercial |
$4,239.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,496.83
|
| Rate for Payer: Cash Price |
$1,413.30
|
| Rate for Payer: Cigna Commercial |
$4,334.12
|
| Rate for Payer: Health EOS Commercial |
$4,192.79
|
| Rate for Payer: HFN Commercial |
$4,334.12
|
| Rate for Payer: Multiplan Commercial |
$3,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,826.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.39
|
| Rate for Payer: Quartz Commercial |
$2,826.60
|
| Rate for Payer: WEA Trust Commercial |
$2,591.05
|
| Rate for Payer: WPS Commercial |
$3,489.44
|
|
|
TAPER POST 12mm
|
Facility
|
IP
|
$4,978.00
|
|
| Hospital Charge Code |
2964733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,439.22 |
| Max. Negotiated Rate |
$4,579.76 |
| Rate for Payer: Aetna Commercial |
$4,480.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.34
|
| Rate for Payer: Cash Price |
$1,493.40
|
| Rate for Payer: Cigna Commercial |
$4,579.76
|
| Rate for Payer: Health EOS Commercial |
$4,430.42
|
| Rate for Payer: HFN Commercial |
$4,579.76
|
| Rate for Payer: Multiplan Commercial |
$3,982.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,986.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.22
|
| Rate for Payer: Quartz Commercial |
$2,986.80
|
| Rate for Payer: WEA Trust Commercial |
$2,737.90
|
| Rate for Payer: WPS Commercial |
$3,687.20
|
|
