|
TAPER POST 12mm
|
Facility
|
OP
|
$4,978.00
|
|
| Hospital Charge Code |
2964733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,393.84 |
| Max. Negotiated Rate |
$19,912.00 |
| Rate for Payer: Aetna Commercial |
$4,480.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,235.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.44
|
| 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: Dean Health DHI/DHP/ASO |
$2,785.69
|
| Rate for Payer: Health EOS Commercial |
$4,430.42
|
| Rate for Payer: HFN Commercial |
$4,579.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.50
|
| 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 |
$3,235.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,986.80
|
| Rate for Payer: The Alliance Commercial |
$19,912.00
|
| Rate for Payer: WEA Trust Commercial |
$2,737.90
|
| Rate for Payer: WPS Commercial |
$3,687.20
|
|
|
TAPER POST 13.7mm
|
Facility
|
IP
|
$5,284.00
|
|
| Hospital Charge Code |
2964734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,589.16 |
| Max. Negotiated Rate |
$4,861.28 |
| Rate for Payer: Aetna Commercial |
$4,755.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,544.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,800.52
|
| Rate for Payer: Cash Price |
$1,585.20
|
| Rate for Payer: Cigna Commercial |
$4,861.28
|
| Rate for Payer: Health EOS Commercial |
$4,702.76
|
| Rate for Payer: HFN Commercial |
$4,861.28
|
| Rate for Payer: Multiplan Commercial |
$4,227.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,861.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.16
|
| Rate for Payer: Quartz Commercial |
$3,170.40
|
| Rate for Payer: WEA Trust Commercial |
$2,906.20
|
| Rate for Payer: WPS Commercial |
$3,913.86
|
|
|
TAPER POST 13.7mm
|
Facility
|
OP
|
$5,284.00
|
|
| Hospital Charge Code |
2964734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,479.52 |
| Max. Negotiated Rate |
$21,136.00 |
| Rate for Payer: Aetna Commercial |
$4,755.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,544.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,479.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,434.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,642.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,536.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,800.52
|
| Rate for Payer: Cash Price |
$1,585.20
|
| Rate for Payer: Cigna Commercial |
$4,861.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,956.93
|
| Rate for Payer: Health EOS Commercial |
$4,702.76
|
| Rate for Payer: HFN Commercial |
$4,861.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,963.00
|
| Rate for Payer: Multiplan Commercial |
$4,227.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,861.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.16
|
| Rate for Payer: Quartz Commercial |
$3,434.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,170.40
|
| Rate for Payer: The Alliance Commercial |
$21,136.00
|
| Rate for Payer: WEA Trust Commercial |
$2,906.20
|
| Rate for Payer: WPS Commercial |
$3,913.86
|
|
|
TAPER POST HEMI-CAP 9095-0018-W
|
Facility
|
IP
|
$4,819.00
|
|
| Hospital Charge Code |
2965213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.31 |
| Max. Negotiated Rate |
$4,433.48 |
| Rate for Payer: Aetna Commercial |
$4,337.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,144.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,554.07
|
| Rate for Payer: Cash Price |
$1,445.70
|
| Rate for Payer: Cigna Commercial |
$4,433.48
|
| Rate for Payer: Health EOS Commercial |
$4,288.91
|
| Rate for Payer: HFN Commercial |
$4,433.48
|
| Rate for Payer: Multiplan Commercial |
$3,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,891.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,433.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.31
|
| Rate for Payer: Quartz Commercial |
$2,891.40
|
| Rate for Payer: WEA Trust Commercial |
$2,650.45
|
| Rate for Payer: WPS Commercial |
$3,569.43
|
|
|
TAPER POST HEMI-CAP 9095-0018-W
|
Facility
|
OP
|
$4,819.00
|
|
| Hospital Charge Code |
2965213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.32 |
| Max. Negotiated Rate |
$19,276.00 |
| Rate for Payer: Aetna Commercial |
$4,337.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,144.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,349.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,132.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,409.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,313.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,554.07
|
| Rate for Payer: Cash Price |
$1,445.70
|
| Rate for Payer: Cigna Commercial |
$4,433.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,696.71
|
| Rate for Payer: Health EOS Commercial |
$4,288.91
|
| Rate for Payer: HFN Commercial |
$4,433.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,614.25
|
| Rate for Payer: Multiplan Commercial |
$3,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,891.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,433.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.31
|
| Rate for Payer: Quartz Commercial |
$3,132.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,891.40
|
| Rate for Payer: The Alliance Commercial |
$19,276.00
|
| Rate for Payer: WEA Trust Commercial |
$2,650.45
|
| Rate for Payer: WPS Commercial |
$3,569.43
|
|
|
TAPE SILK DURAPORE 3'x 10 yrd
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
2962793
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TAPE SILK DURAPORE 3'x 10 yrd
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
2962793
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TAPE-STRIPS 4 x 18 3524
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
2964008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
TAPE-STRIPS 4 x 18 3524
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
2964008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
TAPE UMBILICAL 1/8 X 18
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2963600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
TAPE UMBILICAL 1/8 X 18
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2963600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
TAPE WRAP PREM BLACK 2IN #2640-09
|
Facility
|
IP
|
$902.00
|
|
| Hospital Charge Code |
2974053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$441.98 |
| Max. Negotiated Rate |
$829.84 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$541.20
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
TAPE WRAP PREM BLACK 2IN #2640-09
|
Facility
|
OP
|
$902.00
|
|
| Hospital Charge Code |
2974053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$3,608.00 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.72
|
| Rate for Payer: Aetna Managed Medicare |
$252.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.76
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$586.30
|
| Rate for Payer: Quartz Medicare Advantage |
$541.20
|
| Rate for Payer: The Alliance Commercial |
$3,608.00
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
TAPE WRAP PREM WHITE #2640-10
|
Facility
|
OP
|
$902.00
|
|
| Hospital Charge Code |
2974054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$3,608.00 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.72
|
| Rate for Payer: Aetna Managed Medicare |
$252.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.76
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$586.30
|
| Rate for Payer: Quartz Medicare Advantage |
$541.20
|
| Rate for Payer: The Alliance Commercial |
$3,608.00
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
TAPE WRAP PREM WHITE #2640-10
|
Facility
|
IP
|
$902.00
|
|
| Hospital Charge Code |
2974054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$441.98 |
| Max. Negotiated Rate |
$829.84 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$541.20
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
TAP FOR 3.5MM CORT SCREW GOLD/110MM 311.32
|
Facility
|
IP
|
$1,895.00
|
|
| Hospital Charge Code |
4494462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.55 |
| Max. Negotiated Rate |
$1,743.40 |
| Rate for Payer: Aetna Commercial |
$1,705.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.35
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,743.40
|
| Rate for Payer: Health EOS Commercial |
$1,686.55
|
| Rate for Payer: HFN Commercial |
$1,743.40
|
| Rate for Payer: Multiplan Commercial |
$1,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.40
|
| Rate for Payer: Quartz Beloit One Network |
$928.55
|
| Rate for Payer: Quartz Commercial |
$1,137.00
|
| Rate for Payer: WEA Trust Commercial |
$1,042.25
|
| Rate for Payer: WPS Commercial |
$1,403.63
|
|
|
TAP FOR 3.5MM CORT SCREW GOLD/110MM 311.32
|
Facility
|
OP
|
$1,895.00
|
|
| Hospital Charge Code |
4494462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.60 |
| Max. Negotiated Rate |
$7,580.00 |
| Rate for Payer: Aetna Commercial |
$1,705.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.70
|
| Rate for Payer: Aetna Managed Medicare |
$530.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.35
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,743.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.44
|
| Rate for Payer: Health EOS Commercial |
$1,686.55
|
| Rate for Payer: HFN Commercial |
$1,743.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.25
|
| Rate for Payer: Multiplan Commercial |
$1,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.40
|
| Rate for Payer: Quartz Beloit One Network |
$928.55
|
| Rate for Payer: Quartz Commercial |
$1,231.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,137.00
|
| Rate for Payer: The Alliance Commercial |
$7,580.00
|
| Rate for Payer: WEA Trust Commercial |
$1,042.25
|
| Rate for Payer: WPS Commercial |
$1,403.63
|
|
|
TAP FOR 4.5MM CORTEX/SHAFT SCREWS 130MM/57MM TAP DEPTH 311.46
|
Facility
|
IP
|
$1,428.00
|
|
| Hospital Charge Code |
5521034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.72 |
| Max. Negotiated Rate |
$1,313.76 |
| Rate for Payer: Aetna Commercial |
$1,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.84
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$1,313.76
|
| Rate for Payer: Health EOS Commercial |
$1,270.92
|
| Rate for Payer: HFN Commercial |
$1,313.76
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$856.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.76
|
| Rate for Payer: Quartz Beloit One Network |
$699.72
|
| Rate for Payer: Quartz Commercial |
$856.80
|
| Rate for Payer: WEA Trust Commercial |
$785.40
|
| Rate for Payer: WPS Commercial |
$1,057.72
|
|
|
TAP FOR 4.5MM CORTEX/SHAFT SCREWS 130MM/57MM TAP DEPTH 311.46
|
Facility
|
OP
|
$1,428.00
|
|
| Hospital Charge Code |
5521034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$5,712.00 |
| Rate for Payer: Aetna Commercial |
$1,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.08
|
| Rate for Payer: Aetna Managed Medicare |
$399.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.84
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$1,313.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.11
|
| Rate for Payer: Health EOS Commercial |
$1,270.92
|
| Rate for Payer: HFN Commercial |
$1,313.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$856.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.76
|
| Rate for Payer: Quartz Beloit One Network |
$699.72
|
| Rate for Payer: Quartz Commercial |
$928.20
|
| Rate for Payer: Quartz Medicare Advantage |
$856.80
|
| Rate for Payer: The Alliance Commercial |
$5,712.00
|
| Rate for Payer: WEA Trust Commercial |
$785.40
|
| Rate for Payer: WPS Commercial |
$1,057.72
|
|
|
TARSAL TUNNEL RELEASE
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
TARSAL TUNNEL RELEASE
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
TATTOO SPOT GIS45
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
2973229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Aetna Managed Medicare |
$7.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.08
|
| Rate for Payer: Anthem Medicare Advantage |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.95
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.95
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$11.92
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$306.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7.95
|
| Rate for Payer: The Alliance Commercial |
$31.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: Wellcare Medicare |
$7.95
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
TATTOO SPOT GIS45
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
2973229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.79 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$282.60
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$282.60
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
Taxotere 1 mg Charge
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
2958947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.87
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: HFN Commercial |
$179.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: The Alliance Commercial |
$94.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.87
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$2.18
|
|
|
Taxotere 1 mg Charge
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
2958947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
