|
BANDAGE TIP STOP GTIN-14
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
6207062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
BANDAGE TIP STOP GTIN-14
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
6207062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$18.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.67
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.14
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$39.31
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$42.59
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$32.76
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
BANDAGE TUBULAR ELASTIC SZ 2
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964091
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
BANDAGE TUBULAR ELASTIC SZ 2
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964091
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
BANDAGE TUBULAR ELASTIC SZ 3
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964090
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
BANDAGE TUBULAR ELASTIC SZ 3
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964090
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
BANDAGE TUBULAR ELASTIC SZ 5
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964088
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
BANDAGE TUBULAR ELASTIC SZ 5
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964088
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
BANDAGE TUBULAR ELASTIC SZ 7
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964086
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
BANDAGE TUBULAR ELASTIC SZ 7
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
2964086
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
BAND ANNULOPLASTY SIMULUS
|
Facility
|
IP
|
$9,151.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,663.35 |
| Max. Negotiated Rate |
$8,755.68 |
| Rate for Payer: Aetna Commercial |
$8,565.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,184.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,044.03
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cigna Commercial |
$8,755.68
|
| Rate for Payer: Health EOS Commercial |
$8,470.17
|
| Rate for Payer: HFN Commercial |
$8,755.68
|
| Rate for Payer: Multiplan Commercial |
$7,613.63
|
| Rate for Payer: Preferred Network Access Commercial |
$8,755.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,663.35
|
| Rate for Payer: Quartz Commercial |
$5,710.22
|
| Rate for Payer: WEA Trust Commercial |
$5,234.37
|
| Rate for Payer: WPS Commercial |
$7,049.02
|
|
|
BAND ANNULOPLASTY SIMULUS
|
Facility
|
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.77 |
| Max. Negotiated Rate |
$8,755.68 |
| Rate for Payer: Aetna Commercial |
$8,565.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,184.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,664.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,186.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,758.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,568.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,044.03
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cigna Commercial |
$8,755.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,325.88
|
| Rate for Payer: Health EOS Commercial |
$8,470.17
|
| Rate for Payer: HFN Commercial |
$8,755.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,137.78
|
| Rate for Payer: Multiplan Commercial |
$7,613.63
|
| Rate for Payer: NAPHCARE Commercial |
$5,710.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,755.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,663.35
|
| Rate for Payer: Quartz Commercial |
$6,186.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,710.22
|
| Rate for Payer: The Alliance Commercial |
$4,758.52
|
| Rate for Payer: WEA Trust Commercial |
$5,234.37
|
| Rate for Payer: WPS Commercial |
$7,049.02
|
|
|
BAND GREEN NOVAPLUS/ THERABAND NON-LATEX 50YD #566167
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2969607
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$326.44 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$326.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.38
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$699.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: Quartz Medicare Advantage |
$699.50
|
| Rate for Payer: The Alliance Commercial |
$582.92
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
BAND GREEN NOVAPLUS/ THERABAND NON-LATEX 50YD #566167
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2969607
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
Band-IT
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
2989899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Band-IT
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
2989899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$500.24
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
BAND LIGATOR 6 SHOOTER G24654
|
Facility
|
IP
|
$2,712.00
|
|
| Hospital Charge Code |
5384784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,382.04 |
| Max. Negotiated Rate |
$2,594.84 |
| Rate for Payer: Aetna Commercial |
$2,538.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.85
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,594.84
|
| Rate for Payer: Health EOS Commercial |
$2,510.23
|
| Rate for Payer: HFN Commercial |
$2,594.84
|
| Rate for Payer: Multiplan Commercial |
$2,256.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,382.04
|
| Rate for Payer: Quartz Commercial |
$1,692.29
|
| Rate for Payer: WEA Trust Commercial |
$1,551.26
|
| Rate for Payer: WPS Commercial |
$2,089.05
|
|
|
BAND LIGATOR 6 SHOOTER G24654
|
Facility
|
OP
|
$2,712.00
|
|
| Hospital Charge Code |
5384784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.73 |
| Max. Negotiated Rate |
$2,594.84 |
| Rate for Payer: Aetna Commercial |
$2,538.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.61
|
| Rate for Payer: Aetna Managed Medicare |
$789.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,833.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,410.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,353.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.85
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,594.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,578.38
|
| Rate for Payer: Health EOS Commercial |
$2,510.23
|
| Rate for Payer: HFN Commercial |
$2,594.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,115.36
|
| Rate for Payer: Multiplan Commercial |
$2,256.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,692.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,382.04
|
| Rate for Payer: Quartz Commercial |
$1,833.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.29
|
| Rate for Payer: The Alliance Commercial |
$1,410.24
|
| Rate for Payer: WEA Trust Commercial |
$1,551.26
|
| Rate for Payer: WPS Commercial |
$2,089.05
|
|
|
BAND LIGATOR 7 SHOOTER M00542251
|
Facility
|
IP
|
$3,326.00
|
|
| Hospital Charge Code |
2973636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,694.93 |
| Max. Negotiated Rate |
$3,182.32 |
| Rate for Payer: Aetna Commercial |
$3,113.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,974.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.29
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,182.32
|
| Rate for Payer: Health EOS Commercial |
$3,078.55
|
| Rate for Payer: HFN Commercial |
$3,182.32
|
| Rate for Payer: Multiplan Commercial |
$2,767.23
|
| Rate for Payer: Preferred Network Access Commercial |
$3,182.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.93
|
| Rate for Payer: Quartz Commercial |
$2,075.42
|
| Rate for Payer: WEA Trust Commercial |
$1,902.47
|
| Rate for Payer: WPS Commercial |
$2,562.02
|
|
|
BAND LIGATOR 7 SHOOTER M00542251
|
Facility
|
OP
|
$3,326.00
|
|
| Hospital Charge Code |
2973636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.53 |
| Max. Negotiated Rate |
$3,182.32 |
| Rate for Payer: Aetna Commercial |
$3,113.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,974.77
|
| Rate for Payer: Aetna Managed Medicare |
$968.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,248.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,729.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,660.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.29
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,182.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,935.73
|
| Rate for Payer: Health EOS Commercial |
$3,078.55
|
| Rate for Payer: HFN Commercial |
$3,182.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,594.28
|
| Rate for Payer: Multiplan Commercial |
$2,767.23
|
| Rate for Payer: NAPHCARE Commercial |
$2,075.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,182.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.93
|
| Rate for Payer: Quartz Commercial |
$2,248.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,075.42
|
| Rate for Payer: The Alliance Commercial |
$1,729.52
|
| Rate for Payer: WEA Trust Commercial |
$1,902.47
|
| Rate for Payer: WPS Commercial |
$2,562.02
|
|
|
BAND RED NOVAPLUS/ THERABAND NON-LATEX (LF) 50YD #566166
|
Facility
|
IP
|
$986.00
|
|
| Hospital Charge Code |
2969606
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$502.47 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$615.26
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
|
BAND RED NOVAPLUS/ THERABAND NON-LATEX (LF) 50YD #566166
|
Facility
|
OP
|
$986.00
|
|
| Hospital Charge Code |
2969606
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$287.12 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Aetna Managed Medicare |
$287.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.85
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$769.08
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: NAPHCARE Commercial |
$615.26
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$666.54
|
| Rate for Payer: Quartz Medicare Advantage |
$615.26
|
| Rate for Payer: The Alliance Commercial |
$512.72
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
|
Barbiturate Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Barbiturate Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.95
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Barbiturate Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
