|
Timolol 0.5% Ophth Solution 5ml [Med]
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
2974988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
TIP 0.9MM 30DEG KELMAN PHACO 8065750263
|
Facility
OP
|
$1,190.00
|
|
| Hospital Charge Code |
2964181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Aetna Managed Medicare |
$333.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.92
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.50
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$773.50
|
| Rate for Payer: Quartz Medicare Advantage |
$714.00
|
| Rate for Payer: The Alliance Commercial |
$4,760.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
TIP 0.9MM 30DEG KELMAN PHACO 8065750263
|
Facility
IP
|
$1,190.00
|
|
| Hospital Charge Code |
2964181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.10 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$714.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
TIP FAN SPRAY CO-AXIAL INTERPULSE 0210-18-200***DISC 7/5/17
|
Facility
IP
|
$561.00
|
|
| Hospital Charge Code |
2963188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
TIP FAN SPRAY CO-AXIAL INTERPULSE 0210-18-200***DISC 7/5/17
|
Facility
OP
|
$561.00
|
|
| Hospital Charge Code |
2963188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$2,244.00 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$157.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.75
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$336.60
|
| Rate for Payer: The Alliance Commercial |
$2,244.00
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
TIP HARMONIC 5MM LAP ACE363
|
Facility
IP
|
$5,621.00
|
|
| Hospital Charge Code |
3072548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,754.29 |
| Max. Negotiated Rate |
$5,171.32 |
| Rate for Payer: Aetna Commercial |
$5,058.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,979.13
|
| Rate for Payer: Cash Price |
$1,686.30
|
| Rate for Payer: Cigna Commercial |
$5,171.32
|
| Rate for Payer: Health EOS Commercial |
$5,002.69
|
| Rate for Payer: HFN Commercial |
$5,171.32
|
| Rate for Payer: Multiplan Commercial |
$4,496.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,171.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,754.29
|
| Rate for Payer: Quartz Commercial |
$3,372.60
|
| Rate for Payer: WEA Trust Commercial |
$3,091.55
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
|
TIP HARMONIC 5MM LAP ACE363
|
Facility
OP
|
$5,621.00
|
|
| Hospital Charge Code |
3072548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,573.88 |
| Max. Negotiated Rate |
$22,484.00 |
| Rate for Payer: Aetna Commercial |
$5,058.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,653.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,810.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,698.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,979.13
|
| Rate for Payer: Cash Price |
$1,686.30
|
| Rate for Payer: Cigna Commercial |
$5,171.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,145.51
|
| Rate for Payer: Health EOS Commercial |
$5,002.69
|
| Rate for Payer: HFN Commercial |
$5,171.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,215.75
|
| Rate for Payer: Multiplan Commercial |
$4,496.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,171.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,754.29
|
| Rate for Payer: Quartz Commercial |
$3,653.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,372.60
|
| Rate for Payer: The Alliance Commercial |
$22,484.00
|
| Rate for Payer: WEA Trust Commercial |
$3,091.55
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
|
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 HARMONIC FOCUS HAR9F
|
Facility
IP
|
$5,988.00
|
|
| Hospital Charge Code |
3116531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,934.12 |
| Max. Negotiated Rate |
$5,508.96 |
| Rate for Payer: Aetna Commercial |
$5,389.20
|
| 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: Health EOS Commercial |
$5,329.32
|
| Rate for Payer: HFN Commercial |
$5,508.96
|
| 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 |
$3,592.80
|
| 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: 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
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: 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 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 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: 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
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 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: 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 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: 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
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: 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 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: 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
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
|
|
|
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: 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
|
|
