|
TOURNI-COT X-LG FINGER TXL-4001
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2965771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
TOURNIQUET CUFF 12 IN WITH SLEEVE DISP 60707015200 / MACDT11235SBDT
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
3583502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.81 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$345.07
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
TOURNIQUET CUFF 12 IN WITH SLEEVE DISP 60707015200 / MACDT11235SBDT
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
3583502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Aetna Managed Medicare |
$161.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.85
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.34
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: NAPHCARE Commercial |
$345.07
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$373.83
|
| Rate for Payer: Quartz Medicare Advantage |
$345.07
|
| Rate for Payer: The Alliance Commercial |
$287.56
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
TOURNIQUET CUFF 18 IN DISP 60707015300/60707010300 / MACDTQ184SBDT
|
Facility
|
IP
|
$634.00
|
|
| Hospital Charge Code |
5106986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$323.09 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$395.62
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
TOURNIQUET CUFF 18 IN DISP 60707015300/60707010300 / MACDTQ184SBDT
|
Facility
|
OP
|
$634.00
|
|
| Hospital Charge Code |
5106986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.99
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.52
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$395.62
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$428.58
|
| Rate for Payer: Quartz Medicare Advantage |
$395.62
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
TOURNIQUET CUFF 18 IN DUAL PORT DISP 60707010300SUB
|
Facility
|
IP
|
$439.00
|
|
| Hospital Charge Code |
5307078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TOURNIQUET CUFF 18 IN DUAL PORT DISP 60707010300SUB
|
Facility
|
OP
|
$439.00
|
|
| Hospital Charge Code |
5307078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.50
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$228.28
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
TOURNIQUET CUFF 24 IN DISP 60707015400/60707010400 / MACDTQ244SBDT
|
Facility
|
IP
|
$698.00
|
|
| Hospital Charge Code |
4595307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.70 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Aetna Commercial |
$653.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.74
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$667.85
|
| Rate for Payer: Health EOS Commercial |
$646.07
|
| Rate for Payer: HFN Commercial |
$667.85
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: Preferred Network Access Commercial |
$667.85
|
| Rate for Payer: Quartz Beloit One Network |
$355.70
|
| Rate for Payer: Quartz Commercial |
$435.55
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$537.67
|
|
|
TOURNIQUET CUFF 24 IN DISP 60707015400/60707010400 / MACDTQ244SBDT
|
Facility
|
OP
|
$698.00
|
|
| Hospital Charge Code |
4595307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.26 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Aetna Commercial |
$653.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$203.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.74
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$667.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.24
|
| Rate for Payer: Health EOS Commercial |
$646.07
|
| Rate for Payer: HFN Commercial |
$667.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.44
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$435.55
|
| Rate for Payer: Preferred Network Access Commercial |
$667.85
|
| Rate for Payer: Quartz Beloit One Network |
$355.70
|
| Rate for Payer: Quartz Commercial |
$471.85
|
| Rate for Payer: Quartz Medicare Advantage |
$435.55
|
| Rate for Payer: The Alliance Commercial |
$362.96
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$537.67
|
|
|
TOURNIQUET CUFF 24 IN DUAL PORT DISP 60707010400SUB
|
Facility
|
OP
|
$468.00
|
|
| Hospital Charge Code |
5459181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.28 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Aetna Managed Medicare |
$136.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$316.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.38
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: NAPHCARE Commercial |
$292.03
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$316.37
|
| Rate for Payer: Quartz Medicare Advantage |
$292.03
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
TOURNIQUET CUFF 24 IN DUAL PORT DISP 60707010400SUB
|
Facility
|
IP
|
$468.00
|
|
| Hospital Charge Code |
5459181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.49 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$292.03
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
TOURNIQUET CUFF 30 IN DISP 60707015500/60707010500 / MACDTQ304SBDT
|
Facility
|
OP
|
$755.00
|
|
| Hospital Charge Code |
4641033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.86 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Commercial |
$706.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Aetna Managed Medicare |
$219.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$510.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.16
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$722.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.41
|
| Rate for Payer: Health EOS Commercial |
$698.83
|
| Rate for Payer: HFN Commercial |
$722.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.90
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: NAPHCARE Commercial |
$471.12
|
| Rate for Payer: Preferred Network Access Commercial |
$722.38
|
| Rate for Payer: Quartz Beloit One Network |
$384.75
|
| Rate for Payer: Quartz Commercial |
$510.38
|
| Rate for Payer: Quartz Medicare Advantage |
$471.12
|
| Rate for Payer: The Alliance Commercial |
$392.60
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$581.58
|
|
|
TOURNIQUET CUFF 30 IN DISP 60707015500/60707010500 / MACDTQ304SBDT
|
Facility
|
IP
|
$755.00
|
|
| Hospital Charge Code |
4641033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.75 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Commercial |
$706.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.16
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$722.38
|
| Rate for Payer: Health EOS Commercial |
$698.83
|
| Rate for Payer: HFN Commercial |
$722.38
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: Preferred Network Access Commercial |
$722.38
|
| Rate for Payer: Quartz Beloit One Network |
$384.75
|
| Rate for Payer: Quartz Commercial |
$471.12
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$581.58
|
|
|
TOURNIQUET CUFF 30 IN DUAL PORT DISP 60707010500SUB
|
Facility
|
IP
|
$501.00
|
|
| Hospital Charge Code |
5459182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
TOURNIQUET CUFF 30 IN DUAL PORT DISP 60707010500SUB
|
Facility
|
OP
|
$501.00
|
|
| Hospital Charge Code |
5459182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
TOURNIQUET CUFF 34 IN DISP 60707015600/60707010600 / MACDTQ344SBDT
|
Facility
|
OP
|
$817.00
|
|
| Hospital Charge Code |
4595308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
TOURNIQUET CUFF 34 IN DISP 60707015600/60707010600 / MACDTQ344SBDT
|
Facility
|
IP
|
$817.00
|
|
| Hospital Charge Code |
4595308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
TOURNIQUET CUFF 34 IN DUAL PORT DISP 60707010600SUB
|
Facility
|
OP
|
$502.00
|
|
| Hospital Charge Code |
5685675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.18 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Aetna Managed Medicare |
$146.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.16
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.56
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: NAPHCARE Commercial |
$313.25
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$339.35
|
| Rate for Payer: Quartz Medicare Advantage |
$313.25
|
| Rate for Payer: The Alliance Commercial |
$261.04
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
TOURNIQUET CUFF 34 IN DUAL PORT DISP 60707010600SUB
|
Facility
|
IP
|
$502.00
|
|
| Hospital Charge Code |
5685675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.82 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$313.25
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
TOURNIQUET CUFF 42 IN WITH SLEEVE DISP 60707015700
|
Facility
|
IP
|
$890.00
|
|
| Hospital Charge Code |
4641034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.54 |
| Max. Negotiated Rate |
$851.55 |
| Rate for Payer: Aetna Commercial |
$833.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.57
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$851.55
|
| Rate for Payer: Health EOS Commercial |
$823.78
|
| Rate for Payer: HFN Commercial |
$851.55
|
| Rate for Payer: Multiplan Commercial |
$740.48
|
| Rate for Payer: Preferred Network Access Commercial |
$851.55
|
| Rate for Payer: Quartz Beloit One Network |
$453.54
|
| Rate for Payer: Quartz Commercial |
$555.36
|
| Rate for Payer: WEA Trust Commercial |
$509.08
|
| Rate for Payer: WPS Commercial |
$685.57
|
|
|
TOURNIQUET CUFF 42 IN WITH SLEEVE DISP 60707015700
|
Facility
|
OP
|
$890.00
|
|
| Hospital Charge Code |
4641034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.17 |
| Max. Negotiated Rate |
$851.55 |
| Rate for Payer: Aetna Commercial |
$833.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.02
|
| Rate for Payer: Aetna Managed Medicare |
$259.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.57
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$851.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.98
|
| Rate for Payer: Health EOS Commercial |
$823.78
|
| Rate for Payer: HFN Commercial |
$851.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$694.20
|
| Rate for Payer: Multiplan Commercial |
$740.48
|
| Rate for Payer: NAPHCARE Commercial |
$555.36
|
| Rate for Payer: Preferred Network Access Commercial |
$851.55
|
| Rate for Payer: Quartz Beloit One Network |
$453.54
|
| Rate for Payer: Quartz Commercial |
$601.64
|
| Rate for Payer: Quartz Medicare Advantage |
$555.36
|
| Rate for Payer: The Alliance Commercial |
$462.80
|
| Rate for Payer: WEA Trust Commercial |
$509.08
|
| Rate for Payer: WPS Commercial |
$685.57
|
|
|
TOURNIQUET CUFF 44 IN WITH SLEEVE CONTOUR DISP 60797010700 / MACDTQ444SBDT
|
Facility
|
IP
|
$624.00
|
|
| Hospital Charge Code |
5861739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.99 |
| Max. Negotiated Rate |
$597.04 |
| Rate for Payer: Aetna Commercial |
$584.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.95
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$597.04
|
| Rate for Payer: Health EOS Commercial |
$577.57
|
| Rate for Payer: HFN Commercial |
$597.04
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: Preferred Network Access Commercial |
$597.04
|
| Rate for Payer: Quartz Beloit One Network |
$317.99
|
| Rate for Payer: Quartz Commercial |
$389.38
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$480.67
|
|
|
TOURNIQUET CUFF 44 IN WITH SLEEVE CONTOUR DISP 60797010700 / MACDTQ444SBDT
|
Facility
|
OP
|
$624.00
|
|
| Hospital Charge Code |
5861739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$597.04 |
| Rate for Payer: Aetna Commercial |
$584.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Aetna Managed Medicare |
$181.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.95
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$597.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.17
|
| Rate for Payer: Health EOS Commercial |
$577.57
|
| Rate for Payer: HFN Commercial |
$597.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$486.72
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: NAPHCARE Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$597.04
|
| Rate for Payer: Quartz Beloit One Network |
$317.99
|
| Rate for Payer: Quartz Commercial |
$421.82
|
| Rate for Payer: Quartz Medicare Advantage |
$389.38
|
| Rate for Payer: The Alliance Commercial |
$324.48
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$480.67
|
|
|
TOWEL FENESTRATED POLY LINED
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963129
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
TOWEL FENESTRATED POLY LINED
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963129
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
