|
CUBITAL TUNNEL
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
5130616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
CUFF ADAPTER UNIVERSAL 22mm #1421
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
2969677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
CUFF ADAPTER UNIVERSAL 22mm #1421
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
2969677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
CUFF BLOOD PRESSURE DISP ADULT LONG VSOFT-11L
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
4509021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
CUFF BLOOD PRESSURE DISP ADULT LONG VSOFT-11L
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
4509021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
CUFF BLOOD PRESSURE DISP ADULT VSOFT-11
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
4509020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.81
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| Rate for Payer: Quartz Medicare Advantage |
$38.40
|
| Rate for Payer: The Alliance Commercial |
$256.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
CUFF BLOOD PRESSURE DISP ADULT VSOFT-11
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
4509020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
CUFF BLOOD PRESSURE DISP CHILD VSOFT-09
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
4509018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$25.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$54.00
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
CUFF BLOOD PRESSURE DISP CHILD VSOFT-09
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
4509018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
CUFF BLOOD PRESSURE DISP LARGE ADULT LONG VSOFT-12L
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
4509023
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
CUFF BLOOD PRESSURE DISP LARGE ADULT LONG VSOFT-12L
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
4509023
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
CUFF BLOOD PRESSURE DISP LARGE ADULT VSOFT-12
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
4509022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CUFF BLOOD PRESSURE DISP LARGE ADULT VSOFT-12
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
4509022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CUFF BLOOD PRESSURE DISP SM ADULT VSOFT-10
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
4509019
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
CUFF BLOOD PRESSURE DISP SM ADULT VSOFT-10
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
4509019
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.81
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| Rate for Payer: Quartz Medicare Advantage |
$38.40
|
| Rate for Payer: The Alliance Commercial |
$256.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
CUFF BLOOD PRESSURE DISP SM CHILD SOFT-08
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
4509037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$25.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$54.00
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
CUFF BLOOD PRESSURE DISP SM CHILD SOFT-08
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
4509037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
CUFF BLOOD PRESSURE DISP THIGH SOFT-13
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
4509024
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
CUFF BLOOD PRESSURE DISP THIGH SOFT-13
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
4509024
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$28.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.96
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$65.00
|
| Rate for Payer: Quartz Medicare Advantage |
$60.00
|
| Rate for Payer: The Alliance Commercial |
$400.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
CUFF TOURNIQUET 12 60707500200"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.72 |
| Max. Negotiated Rate |
$2,096.00 |
| Rate for Payer: Aetna Commercial |
$471.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$450.64
|
| Rate for Payer: Aetna Managed Medicare |
$146.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$262.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.72
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$482.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.23
|
| Rate for Payer: Health EOS Commercial |
$466.36
|
| Rate for Payer: HFN Commercial |
$482.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$393.00
|
| Rate for Payer: Multiplan Commercial |
$419.20
|
| Rate for Payer: NAPHCARE Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.08
|
| Rate for Payer: Quartz Beloit One Network |
$256.76
|
| Rate for Payer: Quartz Commercial |
$340.60
|
| Rate for Payer: Quartz Medicare Advantage |
$314.40
|
| Rate for Payer: The Alliance Commercial |
$2,096.00
|
| Rate for Payer: WEA Trust Commercial |
$288.20
|
| Rate for Payer: WPS Commercial |
$388.13
|
|
|
CUFF TOURNIQUET 12 60707500200"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$482.08 |
| Rate for Payer: Aetna Commercial |
$471.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$450.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.72
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$482.08
|
| Rate for Payer: Health EOS Commercial |
$466.36
|
| Rate for Payer: HFN Commercial |
$482.08
|
| Rate for Payer: Multiplan Commercial |
$419.20
|
| Rate for Payer: NAPHCARE Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.08
|
| Rate for Payer: Quartz Beloit One Network |
$256.76
|
| Rate for Payer: Quartz Commercial |
$314.40
|
| Rate for Payer: WEA Trust Commercial |
$288.20
|
| Rate for Payer: WPS Commercial |
$388.13
|
|
|
CUFF TOURNIQUET 18 60707500300"
|
Facility
|
OP
|
$544.00
|
|
| Hospital Charge Code |
2967413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.32 |
| Max. Negotiated Rate |
$2,176.00 |
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.84
|
| Rate for Payer: Aetna Managed Medicare |
$152.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.32
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$500.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.42
|
| Rate for Payer: Health EOS Commercial |
$484.16
|
| Rate for Payer: HFN Commercial |
$500.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: NAPHCARE Commercial |
$326.40
|
| Rate for Payer: Preferred Network Access Commercial |
$500.48
|
| Rate for Payer: Quartz Beloit One Network |
$266.56
|
| Rate for Payer: Quartz Commercial |
$353.60
|
| Rate for Payer: Quartz Medicare Advantage |
$326.40
|
| Rate for Payer: The Alliance Commercial |
$2,176.00
|
| Rate for Payer: WEA Trust Commercial |
$299.20
|
| Rate for Payer: WPS Commercial |
$402.94
|
|
|
CUFF TOURNIQUET 18 60707500300"
|
Facility
|
IP
|
$544.00
|
|
| Hospital Charge Code |
2967413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.56 |
| Max. Negotiated Rate |
$500.48 |
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.32
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$500.48
|
| Rate for Payer: Health EOS Commercial |
$484.16
|
| Rate for Payer: HFN Commercial |
$500.48
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: NAPHCARE Commercial |
$326.40
|
| Rate for Payer: Preferred Network Access Commercial |
$500.48
|
| Rate for Payer: Quartz Beloit One Network |
$266.56
|
| Rate for Payer: Quartz Commercial |
$326.40
|
| Rate for Payer: WEA Trust Commercial |
$299.20
|
| Rate for Payer: WPS Commercial |
$402.94
|
|
|
CUFF TOURNIQUET 24 60707500400"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.72 |
| Max. Negotiated Rate |
$2,096.00 |
| Rate for Payer: Aetna Commercial |
$471.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$450.64
|
| Rate for Payer: Aetna Managed Medicare |
$146.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$262.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.72
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$482.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.23
|
| Rate for Payer: Health EOS Commercial |
$466.36
|
| Rate for Payer: HFN Commercial |
$482.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$393.00
|
| Rate for Payer: Multiplan Commercial |
$419.20
|
| Rate for Payer: NAPHCARE Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.08
|
| Rate for Payer: Quartz Beloit One Network |
$256.76
|
| Rate for Payer: Quartz Commercial |
$340.60
|
| Rate for Payer: Quartz Medicare Advantage |
$314.40
|
| Rate for Payer: The Alliance Commercial |
$2,096.00
|
| Rate for Payer: WEA Trust Commercial |
$288.20
|
| Rate for Payer: WPS Commercial |
$388.13
|
|
|
CUFF TOURNIQUET 24 60707500400"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$482.08 |
| Rate for Payer: Aetna Commercial |
$471.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$450.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.72
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$482.08
|
| Rate for Payer: Health EOS Commercial |
$466.36
|
| Rate for Payer: HFN Commercial |
$482.08
|
| Rate for Payer: Multiplan Commercial |
$419.20
|
| Rate for Payer: NAPHCARE Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.08
|
| Rate for Payer: Quartz Beloit One Network |
$256.76
|
| Rate for Payer: Quartz Commercial |
$314.40
|
| Rate for Payer: WEA Trust Commercial |
$288.20
|
| Rate for Payer: WPS Commercial |
$388.13
|
|
