|
Cartridges-V-Vac Suction Rplmt
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
3040350
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
CARTRIDGE V-VAC SUCTION
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2963615
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$185.95
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
CARTRIDGE V-VAC SUCTION
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2963615
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$86.78 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$86.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$201.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.44
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$232.44
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$185.95
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$201.45
|
| Rate for Payer: Quartz Medicare Advantage |
$185.95
|
| Rate for Payer: The Alliance Commercial |
$154.96
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
CASE CONTACT LENS FLIP TOP
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
2962972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
CASE CONTACT LENS FLIP TOP
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
2962972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
CASH Brace - PT Equipment Issued Rehab
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
2989878
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$342.36 |
| Max. Negotiated Rate |
$2,069.85 |
| Rate for Payer: Aetna Commercial |
$1,548.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,479.34
|
| Rate for Payer: Aetna Managed Medicare |
$481.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$342.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$911.68
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,582.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$962.63
|
| Rate for Payer: Health EOS Commercial |
$1,530.94
|
| Rate for Payer: HFN Commercial |
$1,582.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,290.12
|
| Rate for Payer: Multiplan Commercial |
$1,376.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,032.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,582.55
|
| Rate for Payer: Quartz Beloit One Network |
$842.88
|
| Rate for Payer: Quartz Commercial |
$1,118.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,032.10
|
| Rate for Payer: The Alliance Commercial |
$2,069.85
|
| Rate for Payer: WEA Trust Commercial |
$946.09
|
| Rate for Payer: WPS Commercial |
$1,274.08
|
|
|
CASH Brace - PT Equipment Issued Rehab
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
2989878
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$517.46 |
| Max. Negotiated Rate |
$1,634.15 |
| Rate for Payer: Aetna Commercial |
$1,634.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,479.34
|
| Rate for Payer: Aetna Managed Medicare |
$517.46
|
| Rate for Payer: Anthem Medicare Advantage |
$517.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$517.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$517.46
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,634.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$860.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.46
|
| Rate for Payer: Health EOS Commercial |
$1,565.35
|
| Rate for Payer: HFN Commercial |
$1,634.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,492.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,492.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$517.46
|
| Rate for Payer: Multiplan Commercial |
$1,376.13
|
| Rate for Payer: NAPHCARE Commercial |
$776.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.15
|
| Rate for Payer: Quartz Beloit One Network |
$756.87
|
| Rate for Payer: Quartz Commercial |
$980.49
|
| Rate for Payer: Quartz Medicare Advantage |
$517.46
|
| Rate for Payer: The Alliance Commercial |
$1,423.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$517.46
|
| Rate for Payer: WEA Trust Commercial |
$946.09
|
| Rate for Payer: WPS Commercial |
$905.56
|
|
|
CASH Brace - PT Equipment Issued Rehab
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
HCPCS L0472
|
| Hospital Charge Code |
2989878
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$842.88 |
| Max. Negotiated Rate |
$1,582.55 |
| Rate for Payer: Aetna Commercial |
$1,548.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,479.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$911.68
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,582.55
|
| Rate for Payer: Health EOS Commercial |
$1,530.94
|
| Rate for Payer: HFN Commercial |
$1,582.55
|
| Rate for Payer: Multiplan Commercial |
$1,376.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,582.55
|
| Rate for Payer: Quartz Beloit One Network |
$842.88
|
| Rate for Payer: Quartz Commercial |
$1,032.10
|
| Rate for Payer: WEA Trust Commercial |
$946.09
|
| Rate for Payer: WPS Commercial |
$1,274.08
|
|
|
CASSETTE LIPID PRFL GLU 10-991
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2969763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
CASSETTE LIPID PRFL GLU 10-991
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2969763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
CASSETTE V.A.C. VERALINK WITH ADAPTOR (VERAFLO) ULTLNK0500
|
Facility
|
IP
|
$861.00
|
|
| Hospital Charge Code |
5583408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.77 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$537.26
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
CASSETTE V.A.C. VERALINK WITH ADAPTOR (VERAFLO) ULTLNK0500
|
Facility
|
OP
|
$861.00
|
|
| Hospital Charge Code |
5583408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.72 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Aetna Managed Medicare |
$250.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$429.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.10
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.58
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: NAPHCARE Commercial |
$537.26
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$582.04
|
| Rate for Payer: Quartz Medicare Advantage |
$537.26
|
| Rate for Payer: The Alliance Commercial |
$447.72
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
CAST 2 BLUE SCOTCHCAST
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 2 BLUE SCOTCHCAST
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 2 PINK SCOTCHCAST
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963731
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 2 PINK SCOTCHCAST
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963731
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 BLUE SCOTCHCAST PLUS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963674
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 BLUE SCOTCHCAST PLUS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963674
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 PINK SCOTCHCAST PLUS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963671
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 PINK SCOTCHCAST PLUS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963671
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 PURPLE SCOTCHCAST PLUS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963672
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 PURPLE SCOTCHCAST PLUS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963672
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 RED SCOTCHCAST PLUS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963673
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 3 RED SCOTCHCAST PLUS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963673
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
CAST 4 BLUE SCOTCHCAST PLUS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
