|
DRAPE ALCON APERTURE 8065153120
|
Facility
|
OP
|
$382.00
|
|
| Hospital Charge Code |
5264687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$1,528.00 |
| Rate for Payer: Aetna Commercial |
$343.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Aetna Managed Medicare |
$106.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.46
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$351.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.77
|
| Rate for Payer: Health EOS Commercial |
$339.98
|
| Rate for Payer: HFN Commercial |
$351.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.50
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: NAPHCARE Commercial |
$229.20
|
| Rate for Payer: Preferred Network Access Commercial |
$351.44
|
| Rate for Payer: Quartz Beloit One Network |
$187.18
|
| Rate for Payer: Quartz Commercial |
$248.30
|
| Rate for Payer: Quartz Medicare Advantage |
$229.20
|
| Rate for Payer: The Alliance Commercial |
$1,528.00
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
DRAPE ARTHOSCOPY ORTHOARTS 89267
|
Facility
|
OP
|
$777.00
|
|
| Hospital Charge Code |
2963022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Aetna Managed Medicare |
$217.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.81
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.75
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$466.20
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$505.05
|
| Rate for Payer: Quartz Medicare Advantage |
$466.20
|
| Rate for Payer: The Alliance Commercial |
$3,108.00
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
|
DRAPE ARTHOSCOPY ORTHOARTS 89267
|
Facility
|
IP
|
$777.00
|
|
| Hospital Charge Code |
2963022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.73 |
| Max. Negotiated Rate |
$714.84 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$466.20
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$466.20
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
|
DRAPE BARRIER STERILE FIELD
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
DRAPE BARRIER STERILE FIELD
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
DRAPE BEACH CHAIR 89066
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
6202988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.00
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
DRAPE BEACH CHAIR 89066
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
6202988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Aetna Managed Medicare |
$105.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$243.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.85
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.25
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.00
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$243.75
|
| Rate for Payer: Quartz Medicare Advantage |
$225.00
|
| Rate for Payer: The Alliance Commercial |
$1,500.00
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
DRAPE BRACHIAL ANGIOGRAPHY
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2974748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
DRAPE BRACHIAL ANGIOGRAPHY
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2974748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
DRAPE BUTTOCK POUCH 29.5X44 89415
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
5106622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
DRAPE BUTTOCK POUCH 29.5X44 89415
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
5106622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
DRAPE C-ARM MINI ORTHOSCAN 1000-0100
|
Facility
|
IP
|
$289.00
|
|
| Hospital Charge Code |
3369506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$265.88 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$173.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$173.40
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
|
DRAPE C-ARM MINI ORTHOSCAN 1000-0100
|
Facility
|
OP
|
$289.00
|
|
| Hospital Charge Code |
3369506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Aetna Managed Medicare |
$80.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.72
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.75
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$173.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$187.85
|
| Rate for Payer: Quartz Medicare Advantage |
$173.40
|
| Rate for Payer: The Alliance Commercial |
$1,156.00
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
|
DRAPE C-ARM MOBILE X-RAY 4951
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
2963434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
DRAPE C-ARM MOBILE X-RAY 4951
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
2963434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$39.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.34
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$84.00
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
DRAPE C-ARMOR 5523
|
Facility
|
OP
|
$854.00
|
|
| Hospital Charge Code |
5240715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.12 |
| Max. Negotiated Rate |
$3,416.00 |
| Rate for Payer: Aetna Commercial |
$768.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.44
|
| Rate for Payer: Aetna Managed Medicare |
$239.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.62
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$785.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.90
|
| Rate for Payer: Health EOS Commercial |
$760.06
|
| Rate for Payer: HFN Commercial |
$785.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.50
|
| Rate for Payer: Multiplan Commercial |
$683.20
|
| Rate for Payer: NAPHCARE Commercial |
$512.40
|
| Rate for Payer: Preferred Network Access Commercial |
$785.68
|
| Rate for Payer: Quartz Beloit One Network |
$418.46
|
| Rate for Payer: Quartz Commercial |
$555.10
|
| Rate for Payer: Quartz Medicare Advantage |
$512.40
|
| Rate for Payer: The Alliance Commercial |
$3,416.00
|
| Rate for Payer: WEA Trust Commercial |
$469.70
|
| Rate for Payer: WPS Commercial |
$632.56
|
|
|
DRAPE C-ARMOR 5523
|
Facility
|
IP
|
$854.00
|
|
| Hospital Charge Code |
5240715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.46 |
| Max. Negotiated Rate |
$785.68 |
| Rate for Payer: Aetna Commercial |
$768.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.62
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$785.68
|
| Rate for Payer: Health EOS Commercial |
$760.06
|
| Rate for Payer: HFN Commercial |
$785.68
|
| Rate for Payer: Multiplan Commercial |
$683.20
|
| Rate for Payer: NAPHCARE Commercial |
$512.40
|
| Rate for Payer: Preferred Network Access Commercial |
$785.68
|
| Rate for Payer: Quartz Beloit One Network |
$418.46
|
| Rate for Payer: Quartz Commercial |
$512.40
|
| Rate for Payer: WEA Trust Commercial |
$469.70
|
| Rate for Payer: WPS Commercial |
$632.56
|
|
|
DRAPE CASSETTE LATEX FREE 890010
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
2963355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
DRAPE CASSETTE LATEX FREE 890010
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
2963355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$29.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$63.60
|
| Rate for Payer: The Alliance Commercial |
$424.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
DRAPE CRANIOTOMY W/POUCH
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
2963058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Aetna Managed Medicare |
$128.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.42
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$299.00
|
| Rate for Payer: Quartz Medicare Advantage |
$276.00
|
| Rate for Payer: The Alliance Commercial |
$1,840.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
DRAPE CRANIOTOMY W/POUCH
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
2963058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
DRAPE C-SECTION STERI-DRAPE IOBAN 2 3M 6697
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
2963146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.55 |
| Max. Negotiated Rate |
$639.40 |
| Rate for Payer: Aetna Commercial |
$625.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.35
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$639.40
|
| Rate for Payer: Health EOS Commercial |
$618.55
|
| Rate for Payer: HFN Commercial |
$639.40
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: NAPHCARE Commercial |
$417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$639.40
|
| Rate for Payer: Quartz Beloit One Network |
$340.55
|
| Rate for Payer: Quartz Commercial |
$417.00
|
| Rate for Payer: WEA Trust Commercial |
$382.25
|
| Rate for Payer: WPS Commercial |
$514.79
|
|
|
DRAPE C-SECTION STERI-DRAPE IOBAN 2 3M 6697
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
2963146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$2,780.00 |
| Rate for Payer: Aetna Commercial |
$625.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.70
|
| Rate for Payer: Aetna Managed Medicare |
$194.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$451.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$333.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.35
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$639.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.92
|
| Rate for Payer: Health EOS Commercial |
$618.55
|
| Rate for Payer: HFN Commercial |
$639.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.25
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: NAPHCARE Commercial |
$417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$639.40
|
| Rate for Payer: Quartz Beloit One Network |
$340.55
|
| Rate for Payer: Quartz Commercial |
$451.75
|
| Rate for Payer: Quartz Medicare Advantage |
$417.00
|
| Rate for Payer: The Alliance Commercial |
$2,780.00
|
| Rate for Payer: WEA Trust Commercial |
$382.25
|
| Rate for Payer: WPS Commercial |
$514.79
|
|
|
DRAPE FENESTRATED BLUE DRAPE 17 X 27 PAIN MGT 189A18
|
Facility
|
IP
|
$244.00
|
|
| Hospital Charge Code |
4595222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
DRAPE FENESTRATED BLUE DRAPE 17 X 27 PAIN MGT 189A18
|
Facility
|
OP
|
$244.00
|
|
| Hospital Charge Code |
4595222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$976.00 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| Rate for Payer: Quartz Medicare Advantage |
$146.40
|
| Rate for Payer: The Alliance Commercial |
$976.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
