|
TIP HARMONIC FOCUS HAR9F
|
Facility
|
OP
|
$5,988.00
|
|
| Hospital Charge Code |
3116531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,676.64 |
| Max. Negotiated Rate |
$23,952.00 |
| Rate for Payer: Aetna Commercial |
$5,389.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,149.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,676.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,892.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,994.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,874.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,173.64
|
| Rate for Payer: Cash Price |
$1,796.40
|
| Rate for Payer: Cigna Commercial |
$5,508.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,350.88
|
| Rate for Payer: Health EOS Commercial |
$5,329.32
|
| Rate for Payer: HFN Commercial |
$5,508.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,491.00
|
| Rate for Payer: Multiplan Commercial |
$4,790.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,508.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,934.12
|
| Rate for Payer: Quartz Commercial |
$3,892.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,592.80
|
| Rate for Payer: The Alliance Commercial |
$23,952.00
|
| Rate for Payer: WEA Trust Commercial |
$3,293.40
|
| Rate for Payer: WPS Commercial |
$4,435.31
|
|
|
TIP I/A 0.3MM POLYMER 45 DEG ANGLED 8065751511
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
5895637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
TIP I/A 0.3MM POLYMER 45 DEG ANGLED 8065751511
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
5895637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
TIP I/A 0.3MM POLYMER CURVED 8065751512
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
2964180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.12 |
| Max. Negotiated Rate |
$1,016.00 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Aetna Managed Medicare |
$71.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.62
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$233.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.14
|
| Rate for Payer: Health EOS Commercial |
$226.06
|
| Rate for Payer: HFN Commercial |
$233.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.50
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: NAPHCARE Commercial |
$152.40
|
| Rate for Payer: Preferred Network Access Commercial |
$233.68
|
| Rate for Payer: Quartz Beloit One Network |
$124.46
|
| Rate for Payer: Quartz Commercial |
$165.10
|
| Rate for Payer: Quartz Medicare Advantage |
$152.40
|
| Rate for Payer: The Alliance Commercial |
$1,016.00
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
TIP I/A 0.3MM POLYMER CURVED 8065751512
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
2964180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.46 |
| Max. Negotiated Rate |
$233.68 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.62
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$233.68
|
| Rate for Payer: Health EOS Commercial |
$226.06
|
| Rate for Payer: HFN Commercial |
$233.68
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: NAPHCARE Commercial |
$152.40
|
| Rate for Payer: Preferred Network Access Commercial |
$233.68
|
| Rate for Payer: Quartz Beloit One Network |
$124.46
|
| Rate for Payer: Quartz Commercial |
$152.40
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
TIP KELMAN 45 DEG 0.9MM ABS 8065750853
|
Facility
|
OP
|
$1,481.00
|
|
| Hospital Charge Code |
2964182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.68 |
| Max. Negotiated Rate |
$5,924.00 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Aetna Managed Medicare |
$414.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.75
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$962.65
|
| Rate for Payer: Quartz Medicare Advantage |
$888.60
|
| Rate for Payer: The Alliance Commercial |
$5,924.00
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
TIP KELMAN 45 DEG 0.9MM ABS 8065750853
|
Facility
|
IP
|
$1,481.00
|
|
| Hospital Charge Code |
2964182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$888.60
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
TIP RUMI 10CM GREEN UMG670
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$862.96 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$562.80
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 10CM GREEN UMG670
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.64 |
| Max. Negotiated Rate |
$3,752.00 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Aetna Managed Medicare |
$262.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$469.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$450.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.90
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.50
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$609.70
|
| Rate for Payer: Quartz Medicare Advantage |
$562.80
|
| Rate for Payer: The Alliance Commercial |
$3,752.00
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 12CM ORANGE UMO672
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.64 |
| Max. Negotiated Rate |
$3,752.00 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Aetna Managed Medicare |
$262.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$469.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$450.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.90
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.50
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$609.70
|
| Rate for Payer: Quartz Medicare Advantage |
$562.80
|
| Rate for Payer: The Alliance Commercial |
$3,752.00
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 12CM ORANGE UMO672
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$862.96 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$562.80
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 3.75CM YELLOW UMY514
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.64 |
| Max. Negotiated Rate |
$3,752.00 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Aetna Managed Medicare |
$262.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$469.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$450.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.90
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.50
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$609.70
|
| Rate for Payer: Quartz Medicare Advantage |
$562.80
|
| Rate for Payer: The Alliance Commercial |
$3,752.00
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 3.75CM YELLOW UMY514
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$862.96 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$562.80
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 6CM WHITE UMW676
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$862.96 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$562.80
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 6CM WHITE UMW676
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.64 |
| Max. Negotiated Rate |
$3,752.00 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Aetna Managed Medicare |
$262.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$469.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$450.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.90
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.50
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$609.70
|
| Rate for Payer: Quartz Medicare Advantage |
$562.80
|
| Rate for Payer: The Alliance Commercial |
$3,752.00
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
TIP RUMI 8CM BLUE UMB678
|
Facility
|
IP
|
$934.00
|
|
| Hospital Charge Code |
2964990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.66 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$560.40
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
TIP RUMI 8CM BLUE UMB678
|
Facility
|
OP
|
$934.00
|
|
| Hospital Charge Code |
2964990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.52 |
| Max. Negotiated Rate |
$3,736.00 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Aetna Managed Medicare |
$261.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$607.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$467.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$448.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.67
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.50
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$607.10
|
| Rate for Payer: Quartz Medicare Advantage |
$560.40
|
| Rate for Payer: The Alliance Commercial |
$3,736.00
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
TIPS EAR CANAL WAX IRRIGATION #A1003
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
2970140
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
TIPS EAR CANAL WAX IRRIGATION #A1003
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
2970140
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.80
|
| Rate for Payer: The Alliance Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
TIP VITAL VUE 8886828306
|
Facility
|
OP
|
$2,182.00
|
|
| Hospital Charge Code |
2965537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.96 |
| Max. Negotiated Rate |
$8,728.00 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Aetna Managed Medicare |
$610.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.05
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,636.50
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,418.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.20
|
| Rate for Payer: The Alliance Commercial |
$8,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
TIP VITAL VUE 8886828306
|
Facility
|
IP
|
$2,182.00
|
|
| Hospital Charge Code |
2965537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,069.18 |
| Max. Negotiated Rate |
$2,007.44 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,309.20
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
TISSEEL FIBRIN SEALANT 10ML 1501263 (MED)
|
Facility
|
OP
|
$4,984.00
|
|
| Hospital Charge Code |
4294559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$19,936.00 |
| Rate for Payer: Aetna Commercial |
$4,485.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,239.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,492.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,392.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.52
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,585.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,789.05
|
| Rate for Payer: Health EOS Commercial |
$4,435.76
|
| Rate for Payer: HFN Commercial |
$4,585.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,738.00
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.16
|
| Rate for Payer: Quartz Commercial |
$3,239.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,990.40
|
| Rate for Payer: The Alliance Commercial |
$19,936.00
|
| Rate for Payer: WEA Trust Commercial |
$2,741.20
|
| Rate for Payer: WPS Commercial |
$3,691.65
|
|
|
TISSEEL FIBRIN SEALANT 10ML 1501263 (MED)
|
Facility
|
IP
|
$4,984.00
|
|
| Hospital Charge Code |
4294559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.16 |
| Max. Negotiated Rate |
$4,585.28 |
| Rate for Payer: Aetna Commercial |
$4,485.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.52
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,585.28
|
| Rate for Payer: Health EOS Commercial |
$4,435.76
|
| Rate for Payer: HFN Commercial |
$4,585.28
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.16
|
| Rate for Payer: Quartz Commercial |
$2,990.40
|
| Rate for Payer: WEA Trust Commercial |
$2,741.20
|
| Rate for Payer: WPS Commercial |
$3,691.65
|
|
|
TISSEEL FIBRIN SEALANT 4ML 1501262 (MED)
|
Facility
|
IP
|
$2,707.00
|
|
| Hospital Charge Code |
4294557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,326.43 |
| Max. Negotiated Rate |
$2,490.44 |
| Rate for Payer: Aetna Commercial |
$2,436.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.71
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,490.44
|
| Rate for Payer: Health EOS Commercial |
$2,409.23
|
| Rate for Payer: HFN Commercial |
$2,490.44
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.43
|
| Rate for Payer: Quartz Commercial |
$1,624.20
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
|
TISSEEL FIBRIN SEALANT 4ML 1501262 (MED)
|
Facility
|
OP
|
$2,707.00
|
|
| Hospital Charge Code |
4294557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.96 |
| Max. Negotiated Rate |
$10,828.00 |
| Rate for Payer: Aetna Commercial |
$2,436.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.02
|
| Rate for Payer: Aetna Managed Medicare |
$757.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,759.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,353.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,299.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.71
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,490.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,514.84
|
| Rate for Payer: Health EOS Commercial |
$2,409.23
|
| Rate for Payer: HFN Commercial |
$2,490.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,030.25
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.43
|
| Rate for Payer: Quartz Commercial |
$1,759.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.20
|
| Rate for Payer: The Alliance Commercial |
$10,828.00
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
