|
Veriflex 4.0mm x 12mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 12mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 12mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 16mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 16mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 16mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 8mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 8mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.0mm x 8mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.5mm x 12mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.5mm x 12mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.5mm x 12mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.5mm x 16mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.5mm x 16mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 4.5mm x 16mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 5.0mm x 12mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 5.0mm x 12mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 5.0mm x 12mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 5.0mm x 16mm
|
Professional
|
Both
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,965.90 |
| Max. Negotiated Rate |
$17,199.10 |
| Rate for Payer: Aetna Commercial |
$17,199.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$17,199.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,052.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,862.59
|
| Rate for Payer: Health EOS Commercial |
$16,474.93
|
| Rate for Payer: HFN Commercial |
$17,199.10
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$17,199.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,965.90
|
| Rate for Payer: Quartz Commercial |
$10,319.46
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 5.0mm x 16mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Veriflex 5.0mm x 16mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
Verigene Gram Negative PCR Report
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.61
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$83.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: Wellcare Medicare |
$20.85
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Negative PCR Report
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$82.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$91.75
|
|
|
Verigene Gram Negative PCR Report
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$82.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$91.75
|
|
|
Verigene Gram Negative PCR Report
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.61
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$83.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: Wellcare Medicare |
$20.85
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
