|
BULB ESOPHAGEAL INTUBATION EID200
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
2963256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
BULB PATHFINDER PLUS PA 701
|
Facility
|
IP
|
$884.00
|
|
| Hospital Charge Code |
2967373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.49 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
BULB PATHFINDER PLUS PA 701
|
Facility
|
OP
|
$884.00
|
|
| Hospital Charge Code |
2967373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.42 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Aetna Managed Medicare |
$257.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.49
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.52
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: NAPHCARE Commercial |
$551.62
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$597.58
|
| Rate for Payer: Quartz Medicare Advantage |
$551.62
|
| Rate for Payer: The Alliance Commercial |
$459.68
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
Bulb Syringe
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040349
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Bulb Syringe
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040349
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
BULB XENON REPL.KIT/DISP.LARNG
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2963526
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
BULB XENON REPL.KIT/DISP.LARNG
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2963526
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
BULKING AGENT COAPTITE 1CC M0068903000
|
Facility
|
OP
|
$4,336.00
|
|
|
Service Code
|
HCPCS L8606
|
| Hospital Charge Code |
5382978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$4,148.68 |
| Rate for Payer: Aetna Commercial |
$4,058.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,878.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,262.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,390.00
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cigna Commercial |
$4,148.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,523.55
|
| Rate for Payer: Health EOS Commercial |
$4,013.40
|
| Rate for Payer: HFN Commercial |
$4,148.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,382.08
|
| Rate for Payer: Multiplan Commercial |
$3,607.55
|
| Rate for Payer: NAPHCARE Commercial |
$2,705.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,148.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.63
|
| Rate for Payer: Quartz Commercial |
$2,931.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,705.66
|
| Rate for Payer: The Alliance Commercial |
$1,051.98
|
| Rate for Payer: WEA Trust Commercial |
$2,480.19
|
| Rate for Payer: WPS Commercial |
$3,340.02
|
|
|
BULKING AGENT COAPTITE 1CC M0068903000
|
Facility
|
IP
|
$4,336.00
|
|
|
Service Code
|
HCPCS L8606
|
| Hospital Charge Code |
5382978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,209.63 |
| Max. Negotiated Rate |
$4,148.68 |
| Rate for Payer: Aetna Commercial |
$4,058.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,878.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,390.00
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cigna Commercial |
$4,148.68
|
| Rate for Payer: Health EOS Commercial |
$4,013.40
|
| Rate for Payer: HFN Commercial |
$4,148.68
|
| Rate for Payer: Multiplan Commercial |
$3,607.55
|
| Rate for Payer: Preferred Network Access Commercial |
$4,148.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.63
|
| Rate for Payer: Quartz Commercial |
$2,705.66
|
| Rate for Payer: WEA Trust Commercial |
$2,480.19
|
| Rate for Payer: WPS Commercial |
$3,340.02
|
|
|
Bullous Pemphigoid IgG Antibodies
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5308742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$259.58
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
Bullous Pemphigoid IgG Antibodies
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5308742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Bullous Pemphigoid IgG Antibodies
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5308742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$195.69 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$239.62
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
Bumetanide 0.5mg S0171
|
Professional
|
Both
|
$5.00
|
|
| Hospital Charge Code |
4253676
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.12
|
| Rate for Payer: Health EOS Commercial |
$4.73
|
| Rate for Payer: HFN Commercial |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.94
|
| Rate for Payer: Quartz Beloit One Network |
$2.29
|
| Rate for Payer: Quartz Commercial |
$2.96
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Bumetanide 0.5mg S0171
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
4253676
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| 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: 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 |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Bumetanide 0.5mg S0171
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
4253676
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
Bumetanide JW Waste Charge per 0.5mg
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS S0171 JW
|
| Hospital Charge Code |
5266710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
Bumetanide JW Waste Charge per 0.5mg
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0171 JW
|
| Hospital Charge Code |
5266710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.24
|
| Rate for Payer: Health EOS Commercial |
$9.46
|
| Rate for Payer: HFN Commercial |
$9.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.88
|
| Rate for Payer: Quartz Beloit One Network |
$4.58
|
| Rate for Payer: Quartz Commercial |
$5.93
|
| Rate for Payer: The Alliance Commercial |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
Bumetanide JW Waste Charge per 0.5mg
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS S0171 JW
|
| Hospital Charge Code |
5266710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
BUMPER FOAM
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2970612
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
BUMPER FOAM
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2970612
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
BUMPER PAD
|
Facility
|
IP
|
$3,697.00
|
|
| Hospital Charge Code |
3075867
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,883.99 |
| Max. Negotiated Rate |
$3,537.29 |
| Rate for Payer: Aetna Commercial |
$3,460.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.79
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cigna Commercial |
$3,537.29
|
| Rate for Payer: Health EOS Commercial |
$3,421.94
|
| Rate for Payer: HFN Commercial |
$3,537.29
|
| Rate for Payer: Multiplan Commercial |
$3,075.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,883.99
|
| Rate for Payer: Quartz Commercial |
$2,306.93
|
| Rate for Payer: WEA Trust Commercial |
$2,114.68
|
| Rate for Payer: WPS Commercial |
$2,847.80
|
|
|
BUMPER PAD
|
Facility
|
OP
|
$3,697.00
|
|
| Hospital Charge Code |
3075867
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,076.57 |
| Max. Negotiated Rate |
$3,537.29 |
| Rate for Payer: Aetna Commercial |
$3,460.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,076.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,499.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,922.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,845.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.79
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cigna Commercial |
$3,537.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,151.65
|
| Rate for Payer: Health EOS Commercial |
$3,421.94
|
| Rate for Payer: HFN Commercial |
$3,537.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,883.66
|
| Rate for Payer: Multiplan Commercial |
$3,075.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,306.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,883.99
|
| Rate for Payer: Quartz Commercial |
$2,499.17
|
| Rate for Payer: Quartz Medicare Advantage |
$2,306.93
|
| Rate for Payer: The Alliance Commercial |
$1,922.44
|
| Rate for Payer: WEA Trust Commercial |
$2,114.68
|
| Rate for Payer: WPS Commercial |
$2,847.80
|
|
|
Bumper Pad/Seizure Pads - Devices and Equipment
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
3716169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Bumper Pad/Seizure Pads - Devices and Equipment
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
3716169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
BUMP PACK MIS STERILE MICA 57S1MI08
|
Facility
|
OP
|
$5,660.00
|
|
| Hospital Charge Code |
6199056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,648.19 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,648.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,826.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,943.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,825.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,294.12
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,414.80
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,531.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,826.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,531.84
|
| Rate for Payer: The Alliance Commercial |
$2,943.20
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
