|
TIGHTROPE RT ACL AR-1588RTT
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
Tilt Table Test
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
3052519
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,149.66 |
| Max. Negotiated Rate |
$2,158.54 |
| Rate for Payer: Aetna Commercial |
$2,111.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.51
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,158.54
|
| Rate for Payer: Health EOS Commercial |
$2,088.15
|
| Rate for Payer: HFN Commercial |
$2,158.54
|
| Rate for Payer: Multiplan Commercial |
$1,876.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.66
|
| Rate for Payer: Quartz Commercial |
$1,407.74
|
| Rate for Payer: WEA Trust Commercial |
$1,290.43
|
| Rate for Payer: WPS Commercial |
$1,737.80
|
|
|
Tilt Table Test
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
3052519
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$2,158.54 |
| Rate for Payer: Aetna Commercial |
$2,111.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.77
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.20
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,158.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$2,088.15
|
| Rate for Payer: HFN Commercial |
$2,158.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$1,876.99
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.66
|
| Rate for Payer: Quartz Commercial |
$1,525.06
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: WEA Trust Commercial |
$1,290.43
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$1,737.80
|
|
|
Timolol 0.5% Ophth Solution 5ml [Med]
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2974988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Timolol 0.5% Ophth Solution 5ml [Med]
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2974988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
TIP 0.9MM 30DEG KELMAN PHACO 8065750263
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
2964181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$742.56
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
TIP 0.9MM 30DEG KELMAN PHACO 8065750263
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
2964181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Aetna Managed Medicare |
$346.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.58
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.20
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: NAPHCARE Commercial |
$742.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$804.44
|
| Rate for Payer: Quartz Medicare Advantage |
$742.56
|
| Rate for Payer: The Alliance Commercial |
$618.80
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
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 |
$163.36 |
| Max. Negotiated Rate |
$536.76 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Aetna Managed Medicare |
$163.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.50
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.58
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: NAPHCARE Commercial |
$350.06
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$379.24
|
| Rate for Payer: Quartz Medicare Advantage |
$350.06
|
| Rate for Payer: The Alliance Commercial |
$291.72
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
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 |
$285.89 |
| Max. Negotiated Rate |
$536.76 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$350.06
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
TIP HARMONIC 5MM LAP ACE363
|
Facility
|
IP
|
$5,621.00
|
|
| Hospital Charge Code |
3072548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,864.46 |
| Max. Negotiated Rate |
$5,378.17 |
| Rate for Payer: Aetna Commercial |
$5,261.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.30
|
| Rate for Payer: Cash Price |
$1,686.30
|
| Rate for Payer: Cigna Commercial |
$5,378.17
|
| Rate for Payer: Health EOS Commercial |
$5,202.80
|
| Rate for Payer: HFN Commercial |
$5,378.17
|
| Rate for Payer: Multiplan Commercial |
$4,676.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.17
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.46
|
| Rate for Payer: Quartz Commercial |
$3,507.50
|
| Rate for Payer: WEA Trust Commercial |
$3,215.21
|
| Rate for Payer: WPS Commercial |
$4,329.86
|
|
|
TIP HARMONIC 5MM LAP ACE363
|
Facility
|
OP
|
$5,621.00
|
|
| Hospital Charge Code |
3072548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,636.84 |
| Max. Negotiated Rate |
$5,378.17 |
| Rate for Payer: Aetna Commercial |
$5,261.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,636.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,799.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,922.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,806.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.30
|
| Rate for Payer: Cash Price |
$1,686.30
|
| Rate for Payer: Cigna Commercial |
$5,378.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,271.42
|
| Rate for Payer: Health EOS Commercial |
$5,202.80
|
| Rate for Payer: HFN Commercial |
$5,378.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,384.38
|
| Rate for Payer: Multiplan Commercial |
$4,676.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.17
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.46
|
| Rate for Payer: Quartz Commercial |
$3,799.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,507.50
|
| Rate for Payer: The Alliance Commercial |
$2,922.92
|
| Rate for Payer: WEA Trust Commercial |
$3,215.21
|
| Rate for Payer: WPS Commercial |
$4,329.86
|
|
|
TIP HARMONIC FOCUS HAR9F
|
Facility
|
OP
|
$5,988.00
|
|
| Hospital Charge Code |
3116531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,743.71 |
| Max. Negotiated Rate |
$5,729.32 |
| Rate for Payer: Aetna Commercial |
$5,604.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,355.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,743.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,047.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,113.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,989.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,300.59
|
| Rate for Payer: Cash Price |
$1,796.40
|
| Rate for Payer: Cigna Commercial |
$5,729.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,485.02
|
| Rate for Payer: Health EOS Commercial |
$5,542.49
|
| Rate for Payer: HFN Commercial |
$5,729.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,670.64
|
| Rate for Payer: Multiplan Commercial |
$4,982.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,736.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,729.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,051.48
|
| Rate for Payer: Quartz Commercial |
$4,047.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,736.51
|
| Rate for Payer: The Alliance Commercial |
$3,113.76
|
| Rate for Payer: WEA Trust Commercial |
$3,425.14
|
| Rate for Payer: WPS Commercial |
$4,612.56
|
|
|
TIP HARMONIC FOCUS HAR9F
|
Facility
|
IP
|
$5,988.00
|
|
| Hospital Charge Code |
3116531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,051.48 |
| Max. Negotiated Rate |
$5,729.32 |
| Rate for Payer: Aetna Commercial |
$5,604.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,355.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,300.59
|
| Rate for Payer: Cash Price |
$1,796.40
|
| Rate for Payer: Cigna Commercial |
$5,729.32
|
| Rate for Payer: Health EOS Commercial |
$5,542.49
|
| Rate for Payer: HFN Commercial |
$5,729.32
|
| Rate for Payer: Multiplan Commercial |
$4,982.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,729.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,051.48
|
| Rate for Payer: Quartz Commercial |
$3,736.51
|
| Rate for Payer: WEA Trust Commercial |
$3,425.14
|
| Rate for Payer: WPS Commercial |
$4,612.56
|
|
|
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 |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
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 |
$72.22 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$72.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$154.75
|
| Rate for Payer: The Alliance Commercial |
$128.96
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
TIP I/A 0.3MM POLYMER CURVED 8065751512
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
2964180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.44 |
| Max. Negotiated Rate |
$243.03 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.00
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$243.03
|
| Rate for Payer: Health EOS Commercial |
$235.10
|
| Rate for Payer: HFN Commercial |
$243.03
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: Preferred Network Access Commercial |
$243.03
|
| Rate for Payer: Quartz Beloit One Network |
$129.44
|
| Rate for Payer: Quartz Commercial |
$158.50
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$195.66
|
|
|
TIP I/A 0.3MM POLYMER CURVED 8065751512
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
2964180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$243.03 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.00
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$243.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.83
|
| Rate for Payer: Health EOS Commercial |
$235.10
|
| Rate for Payer: HFN Commercial |
$243.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.12
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: NAPHCARE Commercial |
$158.50
|
| Rate for Payer: Preferred Network Access Commercial |
$243.03
|
| Rate for Payer: Quartz Beloit One Network |
$129.44
|
| Rate for Payer: Quartz Commercial |
$171.70
|
| Rate for Payer: Quartz Medicare Advantage |
$158.50
|
| Rate for Payer: The Alliance Commercial |
$132.08
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$195.66
|
|
|
TIP KELMAN 45 DEG 0.9MM ABS 8065750853
|
Facility
|
OP
|
$1,481.00
|
|
| Hospital Charge Code |
2964182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.27 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$431.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,001.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$770.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$739.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.94
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,155.18
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$924.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$1,001.16
|
| Rate for Payer: Quartz Medicare Advantage |
$924.14
|
| Rate for Payer: The Alliance Commercial |
$770.12
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
TIP KELMAN 45 DEG 0.9MM ABS 8065750853
|
Facility
|
IP
|
$1,481.00
|
|
| Hospital Charge Code |
2964182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.72 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$924.14
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
TIP RUMI 10CM GREEN UMG670
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.15 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Aetna Managed Medicare |
$273.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$634.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$487.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$545.92
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$731.64
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: NAPHCARE Commercial |
$585.31
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$634.09
|
| Rate for Payer: Quartz Medicare Advantage |
$585.31
|
| Rate for Payer: The Alliance Commercial |
$487.76
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
TIP RUMI 10CM GREEN UMG670
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$585.31
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
TIP RUMI 12CM ORANGE UMO672
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$585.31
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
TIP RUMI 12CM ORANGE UMO672
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.15 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Aetna Managed Medicare |
$273.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$634.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$487.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$545.92
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$731.64
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: NAPHCARE Commercial |
$585.31
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$634.09
|
| Rate for Payer: Quartz Medicare Advantage |
$585.31
|
| Rate for Payer: The Alliance Commercial |
$487.76
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
TIP RUMI 3.75CM YELLOW UMY514
|
Facility
|
OP
|
$938.00
|
|
| Hospital Charge Code |
2964995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.15 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Aetna Managed Medicare |
$273.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$634.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$487.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$545.92
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$731.64
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: NAPHCARE Commercial |
$585.31
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$634.09
|
| Rate for Payer: Quartz Medicare Advantage |
$585.31
|
| Rate for Payer: The Alliance Commercial |
$487.76
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
TIP RUMI 3.75CM YELLOW UMY514
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
2964995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$585.31
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
