|
VENT TUBE EAR T-TUBE GROMMET ET-GTGST-50 VT-0403-01
|
Facility
OP
|
$438.00
|
|
| Hospital Charge Code |
5107219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Aetna Managed Medicare |
$122.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.14
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$402.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.10
|
| Rate for Payer: Health EOS Commercial |
$389.82
|
| Rate for Payer: HFN Commercial |
$402.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.50
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: NAPHCARE Commercial |
$262.80
|
| Rate for Payer: Preferred Network Access Commercial |
$402.96
|
| Rate for Payer: Quartz Beloit One Network |
$214.62
|
| Rate for Payer: Quartz Commercial |
$284.70
|
| Rate for Payer: Quartz Medicare Advantage |
$262.80
|
| Rate for Payer: The Alliance Commercial |
$1,752.00
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$324.43
|
|
|
VENT TUBE EAR T-TUBE MODIFIED 1.32X4.80MM SILICONE BLUE 240072
|
Facility
IP
|
$523.00
|
|
| Hospital Charge Code |
2965128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
VENT TUBE EAR T-TUBE MODIFIED 1.32X4.80MM SILICONE BLUE 240072
|
Facility
OP
|
$523.00
|
|
| Hospital Charge Code |
2965128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
VENT TUBE EAR TUEBINGER 2-EYELET GOLD PLATINUM LONG TERM 1015065
|
Facility
IP
|
$831.00
|
|
| Hospital Charge Code |
4366022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.19 |
| Max. Negotiated Rate |
$764.52 |
| Rate for Payer: Aetna Commercial |
$747.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.43
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna Commercial |
$764.52
|
| Rate for Payer: Health EOS Commercial |
$739.59
|
| Rate for Payer: HFN Commercial |
$764.52
|
| Rate for Payer: Multiplan Commercial |
$664.80
|
| Rate for Payer: NAPHCARE Commercial |
$498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$764.52
|
| Rate for Payer: Quartz Beloit One Network |
$407.19
|
| Rate for Payer: Quartz Commercial |
$498.60
|
| Rate for Payer: WEA Trust Commercial |
$457.05
|
| Rate for Payer: WPS Commercial |
$615.52
|
|
|
VENT TUBE EAR TUEBINGER 2-EYELET GOLD PLATINUM LONG TERM 1015065
|
Facility
OP
|
$831.00
|
|
| Hospital Charge Code |
4366022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.68 |
| Max. Negotiated Rate |
$3,324.00 |
| Rate for Payer: Aetna Commercial |
$747.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.66
|
| Rate for Payer: Aetna Managed Medicare |
$232.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.43
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna Commercial |
$764.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.03
|
| Rate for Payer: Health EOS Commercial |
$739.59
|
| Rate for Payer: HFN Commercial |
$764.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.25
|
| Rate for Payer: Multiplan Commercial |
$664.80
|
| Rate for Payer: NAPHCARE Commercial |
$498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$764.52
|
| Rate for Payer: Quartz Beloit One Network |
$407.19
|
| Rate for Payer: Quartz Commercial |
$540.15
|
| Rate for Payer: Quartz Medicare Advantage |
$498.60
|
| Rate for Payer: The Alliance Commercial |
$3,324.00
|
| Rate for Payer: WEA Trust Commercial |
$457.05
|
| Rate for Payer: WPS Commercial |
$615.52
|
|
|
Verapamil Level
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5364649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$84.75
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Verapamil Level
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5364649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Verapamil Level
|
Professional
|
$113.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5364649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna Commercial |
$107.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$107.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$102.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Preferred Network Access Commercial |
$107.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.72
|
| Rate for Payer: Quartz Commercial |
$64.41
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Verbalizes understanding
|
Facility
IP
|
$53.00
|
|
| Hospital Charge Code |
2990166
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
2990170
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
2990162
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
IP
|
$53.00
|
|
| Hospital Charge Code |
2990174
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
2990174
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
IP
|
$53.00
|
|
| Hospital Charge Code |
2990162
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
IP
|
$53.00
|
|
| Hospital Charge Code |
2990170
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Verbalizes understanding
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
2990166
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Veriflex 2.75mm x 12mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 12mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 12mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 16mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 16mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 16mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 8mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 2.75mm x 8mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: WPS Commercial |
$12,894.11
|
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
|
|
Veriflex 2.75mm x 8mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
