|
BANDAGE TUBULAR ELASTIC SZ 2
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964091
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
BANDAGE TUBULAR ELASTIC SZ 3
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964090
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
BANDAGE TUBULAR ELASTIC SZ 3
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964090
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
BANDAGE TUBULAR ELASTIC SZ 5
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964088
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
BANDAGE TUBULAR ELASTIC SZ 5
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964088
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
BANDAGE TUBULAR ELASTIC SZ 7
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964086
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
BANDAGE TUBULAR ELASTIC SZ 7
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964086
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
BAND ANNULOPLASTY SIMULUS
|
Facility
|
IP
|
$9,151.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,483.99 |
| Max. Negotiated Rate |
$8,418.92 |
| Rate for Payer: Aetna Commercial |
$8,235.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,869.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.03
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cigna Commercial |
$8,418.92
|
| Rate for Payer: Health EOS Commercial |
$8,144.39
|
| Rate for Payer: HFN Commercial |
$8,418.92
|
| Rate for Payer: Multiplan Commercial |
$7,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,490.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,418.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,483.99
|
| Rate for Payer: Quartz Commercial |
$5,490.60
|
| Rate for Payer: WEA Trust Commercial |
$5,033.05
|
| Rate for Payer: WPS Commercial |
$6,778.15
|
|
|
BAND ANNULOPLASTY SIMULUS
|
Facility
|
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,562.28 |
| Max. Negotiated Rate |
$36,604.00 |
| Rate for Payer: Aetna Commercial |
$8,235.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,869.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,562.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,948.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,575.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,392.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.03
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cigna Commercial |
$8,418.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,120.90
|
| Rate for Payer: Health EOS Commercial |
$8,144.39
|
| Rate for Payer: HFN Commercial |
$8,418.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,863.25
|
| Rate for Payer: Multiplan Commercial |
$7,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,490.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,418.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,483.99
|
| Rate for Payer: Quartz Commercial |
$5,948.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,490.60
|
| Rate for Payer: The Alliance Commercial |
$36,604.00
|
| Rate for Payer: WEA Trust Commercial |
$5,033.05
|
| Rate for Payer: WPS Commercial |
$6,778.15
|
|
|
BAND GREEN NOVAPLUS/ THERABAND NON-LATEX 50YD #566167
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2969607
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$313.88 |
| Max. Negotiated Rate |
$4,484.00 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Aetna Managed Medicare |
$313.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.31
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.75
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$728.65
|
| Rate for Payer: Quartz Medicare Advantage |
$672.60
|
| Rate for Payer: The Alliance Commercial |
$4,484.00
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
BAND GREEN NOVAPLUS/ THERABAND NON-LATEX 50YD #566167
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2969607
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$672.60
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
Band-IT
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
2989899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$31.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.23
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$67.80
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Band-IT
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
2989899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
BAND LIGATOR 6 SHOOTER G24654
|
Facility
|
OP
|
$2,712.00
|
|
| Hospital Charge Code |
5384784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.36 |
| Max. Negotiated Rate |
$10,848.00 |
| Rate for Payer: Aetna Commercial |
$2,440.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.32
|
| Rate for Payer: Aetna Managed Medicare |
$759.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,762.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,356.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,301.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.36
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,495.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,517.64
|
| Rate for Payer: Health EOS Commercial |
$2,413.68
|
| Rate for Payer: HFN Commercial |
$2,495.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,034.00
|
| Rate for Payer: Multiplan Commercial |
$2,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,627.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.88
|
| Rate for Payer: Quartz Commercial |
$1,762.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,627.20
|
| Rate for Payer: The Alliance Commercial |
$10,848.00
|
| Rate for Payer: WEA Trust Commercial |
$1,491.60
|
| Rate for Payer: WPS Commercial |
$2,008.78
|
|
|
BAND LIGATOR 6 SHOOTER G24654
|
Facility
|
IP
|
$2,712.00
|
|
| Hospital Charge Code |
5384784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,328.88 |
| Max. Negotiated Rate |
$2,495.04 |
| Rate for Payer: Aetna Commercial |
$2,440.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.36
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,495.04
|
| Rate for Payer: Health EOS Commercial |
$2,413.68
|
| Rate for Payer: HFN Commercial |
$2,495.04
|
| Rate for Payer: Multiplan Commercial |
$2,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,627.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.88
|
| Rate for Payer: Quartz Commercial |
$1,627.20
|
| Rate for Payer: WEA Trust Commercial |
$1,491.60
|
| Rate for Payer: WPS Commercial |
$2,008.78
|
|
|
BAND LIGATOR 7 SHOOTER M00542251
|
Facility
|
OP
|
$3,326.00
|
|
| Hospital Charge Code |
2973636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.28 |
| Max. Negotiated Rate |
$13,304.00 |
| Rate for Payer: Aetna Commercial |
$2,993.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.36
|
| Rate for Payer: Aetna Managed Medicare |
$931.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,663.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.78
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,059.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,861.23
|
| Rate for Payer: Health EOS Commercial |
$2,960.14
|
| Rate for Payer: HFN Commercial |
$3,059.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,494.50
|
| Rate for Payer: Multiplan Commercial |
$2,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,995.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.74
|
| Rate for Payer: Quartz Commercial |
$2,161.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,995.60
|
| Rate for Payer: The Alliance Commercial |
$13,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,829.30
|
| Rate for Payer: WPS Commercial |
$2,463.57
|
|
|
BAND LIGATOR 7 SHOOTER M00542251
|
Facility
|
IP
|
$3,326.00
|
|
| Hospital Charge Code |
2973636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,629.74 |
| Max. Negotiated Rate |
$3,059.92 |
| Rate for Payer: Aetna Commercial |
$2,993.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.78
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,059.92
|
| Rate for Payer: Health EOS Commercial |
$2,960.14
|
| Rate for Payer: HFN Commercial |
$3,059.92
|
| Rate for Payer: Multiplan Commercial |
$2,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,995.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.74
|
| Rate for Payer: Quartz Commercial |
$1,995.60
|
| Rate for Payer: WEA Trust Commercial |
$1,829.30
|
| Rate for Payer: WPS Commercial |
$2,463.57
|
|
|
BAND RED NOVAPLUS/ THERABAND NON-LATEX (LF) 50YD #566166
|
Facility
|
OP
|
$986.00
|
|
| Hospital Charge Code |
2969606
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$276.08 |
| Max. Negotiated Rate |
$3,944.00 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.96
|
| Rate for Payer: Aetna Managed Medicare |
$276.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$493.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$473.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.58
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$907.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.77
|
| Rate for Payer: Health EOS Commercial |
$877.54
|
| Rate for Payer: HFN Commercial |
$907.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.50
|
| Rate for Payer: Multiplan Commercial |
$788.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.60
|
| Rate for Payer: Preferred Network Access Commercial |
$907.12
|
| Rate for Payer: Quartz Beloit One Network |
$483.14
|
| Rate for Payer: Quartz Commercial |
$640.90
|
| Rate for Payer: Quartz Medicare Advantage |
$591.60
|
| Rate for Payer: The Alliance Commercial |
$3,944.00
|
| Rate for Payer: WEA Trust Commercial |
$542.30
|
| Rate for Payer: WPS Commercial |
$730.33
|
|
|
BAND RED NOVAPLUS/ THERABAND NON-LATEX (LF) 50YD #566166
|
Facility
|
IP
|
$986.00
|
|
| Hospital Charge Code |
2969606
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$483.14 |
| Max. Negotiated Rate |
$907.12 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.58
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$907.12
|
| Rate for Payer: Health EOS Commercial |
$877.54
|
| Rate for Payer: HFN Commercial |
$907.12
|
| Rate for Payer: Multiplan Commercial |
$788.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.60
|
| Rate for Payer: Preferred Network Access Commercial |
$907.12
|
| Rate for Payer: Quartz Beloit One Network |
$483.14
|
| Rate for Payer: Quartz Commercial |
$591.60
|
| Rate for Payer: WEA Trust Commercial |
$542.30
|
| Rate for Payer: WPS Commercial |
$730.33
|
|
|
Barbiturate Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Barbiturate Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Barbiturate Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
BARD IVC ECLIPSE FILTER JUGU
|
Facility
|
OP
|
$10,066.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
2973750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,818.48 |
| Max. Negotiated Rate |
$40,264.00 |
| Rate for Payer: Aetna Commercial |
$9,059.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,656.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,818.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,542.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,831.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,334.98
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cigna Commercial |
$9,260.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,632.93
|
| Rate for Payer: Health EOS Commercial |
$8,958.74
|
| Rate for Payer: HFN Commercial |
$9,260.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,549.50
|
| Rate for Payer: Multiplan Commercial |
$8,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,039.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,260.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.34
|
| Rate for Payer: Quartz Commercial |
$6,542.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,039.60
|
| Rate for Payer: The Alliance Commercial |
$40,264.00
|
| Rate for Payer: WEA Trust Commercial |
$5,536.30
|
| Rate for Payer: WPS Commercial |
$7,455.89
|
|
|
BARD IVC ECLIPSE FILTER JUGU
|
Facility
|
IP
|
$10,066.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
2973750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,932.34 |
| Max. Negotiated Rate |
$9,260.72 |
| Rate for Payer: Aetna Commercial |
$9,059.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,656.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,334.98
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cigna Commercial |
$9,260.72
|
| Rate for Payer: Health EOS Commercial |
$8,958.74
|
| Rate for Payer: HFN Commercial |
$9,260.72
|
| Rate for Payer: Multiplan Commercial |
$8,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,039.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,260.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.34
|
| Rate for Payer: Quartz Commercial |
$6,039.60
|
| Rate for Payer: WEA Trust Commercial |
$5,536.30
|
| Rate for Payer: WPS Commercial |
$7,455.89
|
|
|
Barewire for NAVG Filter
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5460726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,085.35 |
| Max. Negotiated Rate |
$2,037.80 |
| Rate for Payer: Aetna Commercial |
$1,993.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.95
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,037.80
|
| Rate for Payer: Health EOS Commercial |
$1,971.35
|
| Rate for Payer: HFN Commercial |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$1,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.35
|
| Rate for Payer: Quartz Commercial |
$1,329.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.25
|
| Rate for Payer: WPS Commercial |
$1,640.65
|
|
