|
TOURNIQUET CUFF 24 IN DUAL PORT DISP 60707010400SUB
|
Facility
|
IP
|
$468.00
|
|
| Hospital Charge Code |
5459181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
TOURNIQUET CUFF 30 IN DISP 60707015500/60707010500 / MACDTQ304SBDT
|
Facility
|
IP
|
$755.00
|
|
| Hospital Charge Code |
4641033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.95 |
| Max. Negotiated Rate |
$694.60 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$453.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
TOURNIQUET CUFF 30 IN DISP 60707015500/60707010500 / MACDTQ304SBDT
|
Facility
|
OP
|
$755.00
|
|
| Hospital Charge Code |
4641033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$3,020.00 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Aetna Managed Medicare |
$211.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$362.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.50
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.25
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$490.75
|
| Rate for Payer: Quartz Medicare Advantage |
$453.00
|
| Rate for Payer: The Alliance Commercial |
$3,020.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
TOURNIQUET CUFF 30 IN DUAL PORT DISP 60707010500SUB
|
Facility
|
IP
|
$501.00
|
|
| Hospital Charge Code |
5459182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
TOURNIQUET CUFF 30 IN DUAL PORT DISP 60707010500SUB
|
Facility
|
OP
|
$501.00
|
|
| Hospital Charge Code |
5459182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
TOURNIQUET CUFF 34 IN DISP 60707015600/60707010600 / MACDTQ344SBDT
|
Facility
|
IP
|
$817.00
|
|
| Hospital Charge Code |
4595308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
TOURNIQUET CUFF 34 IN DISP 60707015600/60707010600 / MACDTQ344SBDT
|
Facility
|
OP
|
$817.00
|
|
| Hospital Charge Code |
4595308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
TOURNIQUET CUFF 34 IN DUAL PORT DISP 60707010600SUB
|
Facility
|
IP
|
$502.00
|
|
| Hospital Charge Code |
5685675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$301.20
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
TOURNIQUET CUFF 34 IN DUAL PORT DISP 60707010600SUB
|
Facility
|
OP
|
$502.00
|
|
| Hospital Charge Code |
5685675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$140.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.92
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.50
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$301.20
|
| Rate for Payer: The Alliance Commercial |
$2,008.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
TOURNIQUET CUFF 42 IN WITH SLEEVE DISP 60707015700
|
Facility
|
IP
|
$890.00
|
|
| Hospital Charge Code |
4641034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$818.80 |
| Rate for Payer: Aetna Commercial |
$801.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$765.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.70
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$818.80
|
| Rate for Payer: Health EOS Commercial |
$792.10
|
| Rate for Payer: HFN Commercial |
$818.80
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: NAPHCARE Commercial |
$534.00
|
| Rate for Payer: Preferred Network Access Commercial |
$818.80
|
| Rate for Payer: Quartz Beloit One Network |
$436.10
|
| Rate for Payer: Quartz Commercial |
$534.00
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
TOURNIQUET CUFF 42 IN WITH SLEEVE DISP 60707015700
|
Facility
|
OP
|
$890.00
|
|
| Hospital Charge Code |
4641034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$3,560.00 |
| Rate for Payer: Aetna Commercial |
$801.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$765.40
|
| Rate for Payer: Aetna Managed Medicare |
$249.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$578.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$445.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.70
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$818.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.04
|
| Rate for Payer: Health EOS Commercial |
$792.10
|
| Rate for Payer: HFN Commercial |
$818.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$667.50
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: NAPHCARE Commercial |
$534.00
|
| Rate for Payer: Preferred Network Access Commercial |
$818.80
|
| Rate for Payer: Quartz Beloit One Network |
$436.10
|
| Rate for Payer: Quartz Commercial |
$578.50
|
| Rate for Payer: Quartz Medicare Advantage |
$534.00
|
| Rate for Payer: The Alliance Commercial |
$3,560.00
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
TOURNIQUET CUFF 44 IN WITH SLEEVE CONTOUR DISP 60797010700 / MACDTQ444SBDT
|
Facility
|
IP
|
$624.00
|
|
| Hospital Charge Code |
5861739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
TOURNIQUET CUFF 44 IN WITH SLEEVE CONTOUR DISP 60797010700 / MACDTQ444SBDT
|
Facility
|
OP
|
$624.00
|
|
| Hospital Charge Code |
5861739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Aetna Managed Medicare |
$174.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$405.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$312.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$299.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.19
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: Quartz Medicare Advantage |
$374.40
|
| Rate for Payer: The Alliance Commercial |
$2,496.00
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
TOWEL FENESTRATED POLY LINED
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963129
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
TOWEL FENESTRATED POLY LINED
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963129
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
TOWEL POLY LINED #696
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2972747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
TOWEL POLY LINED #696
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2972747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Toxicology Screen Urine
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
993777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Aetna Commercial |
$685.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.92
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$685.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.20
|
| Rate for Payer: Health EOS Commercial |
$657.02
|
| Rate for Payer: HFN Commercial |
$685.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$577.60
|
| Rate for Payer: Preferred Network Access Commercial |
$685.90
|
| Rate for Payer: Quartz Beloit One Network |
$317.68
|
| Rate for Payer: Quartz Commercial |
$411.54
|
| Rate for Payer: The Alliance Commercial |
$361.00
|
| Rate for Payer: WEA Trust Commercial |
$397.10
|
| Rate for Payer: WPS Commercial |
$534.79
|
|
|
Toxicology Screen Urine
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
993777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.78 |
| Max. Negotiated Rate |
$664.24 |
| Rate for Payer: Aetna Commercial |
$649.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.66
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$664.24
|
| Rate for Payer: Health EOS Commercial |
$642.58
|
| Rate for Payer: HFN Commercial |
$664.24
|
| Rate for Payer: Multiplan Commercial |
$577.60
|
| Rate for Payer: NAPHCARE Commercial |
$433.20
|
| Rate for Payer: Preferred Network Access Commercial |
$664.24
|
| Rate for Payer: Quartz Beloit One Network |
$353.78
|
| Rate for Payer: Quartz Commercial |
$433.20
|
| Rate for Payer: WEA Trust Commercial |
$397.10
|
| Rate for Payer: WPS Commercial |
$534.79
|
|
|
Toxicology Screen Urine
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
993777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$664.24 |
| Rate for Payer: Aetna Commercial |
$649.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.92
|
| Rate for Payer: Aetna Managed Medicare |
$17.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.45
|
| Rate for Payer: Anthem Medicaid |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.14
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$664.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.03
|
| Rate for Payer: Dean Health Medicaid |
$17.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.14
|
| Rate for Payer: Health EOS Commercial |
$642.58
|
| Rate for Payer: HFN Commercial |
$664.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.14
|
| Rate for Payer: Managed Health Services Medicaid |
$18.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$577.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.71
|
| Rate for Payer: Preferred Network Access Commercial |
$664.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.71
|
| Rate for Payer: Quartz Beloit One Network |
$353.78
|
| Rate for Payer: Quartz Commercial |
$469.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.14
|
| Rate for Payer: The Alliance Commercial |
$68.56
|
| Rate for Payer: United Healthcare Medicaid |
$17.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.14
|
| Rate for Payer: United Healthcare PPO |
$541.50
|
| Rate for Payer: WEA Trust Commercial |
$397.10
|
| Rate for Payer: Wellcare Medicare |
$17.14
|
| Rate for Payer: WMAP Medicaid |
$17.71
|
| Rate for Payer: WPS Commercial |
$534.79
|
|
|
Toxocara Antibody IgG
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
978081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Toxocara Antibody IgG
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
978081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$100.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.60
|
| Rate for Payer: Health EOS Commercial |
$96.46
|
| Rate for Payer: HFN Commercial |
$100.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Preferred Network Access Commercial |
$100.70
|
| Rate for Payer: Quartz Beloit One Network |
$46.64
|
| Rate for Payer: Quartz Commercial |
$60.42
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Toxocara Antibody IgG
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
978081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$79.50
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Toxoplasma Antibody IgG
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna Commercial |
$175.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$175.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.00
|
| Rate for Payer: Health EOS Commercial |
$168.35
|
| Rate for Payer: HFN Commercial |
$175.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$175.75
|
| Rate for Payer: Quartz Beloit One Network |
$81.40
|
| Rate for Payer: Quartz Commercial |
$105.45
|
| Rate for Payer: The Alliance Commercial |
$92.50
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
Toxoplasma Antibody IgG
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.89
|
| Rate for Payer: Anthem Medicaid |
$14.87
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.53
|
| Rate for Payer: Dean Health Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Managed Health Services Medicaid |
$15.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.58
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.87
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$120.25
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$57.56
|
| Rate for Payer: United Healthcare Medicaid |
$14.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare PPO |
$138.75
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: WMAP Medicaid |
$14.87
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
