|
CUFF TOURNIQUET 34 60707500600"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967415
|
|
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 34 60707500600"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967415
|
|
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 42 60707500700"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967416
|
|
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 42 60707500700"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967416
|
|
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 WITH IZ AMS 800 5.0CM 72404132
|
Facility
|
IP
|
$35,557.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
5563285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17,422.93 |
| Max. Negotiated Rate |
$32,712.44 |
| Rate for Payer: Aetna Commercial |
$32,001.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,579.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,845.21
|
| Rate for Payer: Cash Price |
$10,667.10
|
| Rate for Payer: Cigna Commercial |
$32,712.44
|
| Rate for Payer: Health EOS Commercial |
$31,645.73
|
| Rate for Payer: HFN Commercial |
$32,712.44
|
| Rate for Payer: Multiplan Commercial |
$28,445.60
|
| Rate for Payer: NAPHCARE Commercial |
$21,334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$32,712.44
|
| Rate for Payer: Quartz Beloit One Network |
$17,422.93
|
| Rate for Payer: Quartz Commercial |
$21,334.20
|
| Rate for Payer: WEA Trust Commercial |
$19,556.35
|
| Rate for Payer: WPS Commercial |
$26,337.07
|
|
|
CUFF WITH IZ AMS 800 5.0CM 72404132
|
Facility
|
OP
|
$35,557.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
5563285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,955.96 |
| Max. Negotiated Rate |
$142,228.00 |
| Rate for Payer: Aetna Commercial |
$32,001.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,579.02
|
| Rate for Payer: Aetna Managed Medicare |
$9,955.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,112.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,778.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,067.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,845.21
|
| Rate for Payer: Cash Price |
$10,667.10
|
| Rate for Payer: Cigna Commercial |
$32,712.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,897.70
|
| Rate for Payer: Health EOS Commercial |
$31,645.73
|
| Rate for Payer: HFN Commercial |
$32,712.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,667.75
|
| Rate for Payer: Multiplan Commercial |
$28,445.60
|
| Rate for Payer: NAPHCARE Commercial |
$21,334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$32,712.44
|
| Rate for Payer: Quartz Beloit One Network |
$17,422.93
|
| Rate for Payer: Quartz Commercial |
$23,112.05
|
| Rate for Payer: Quartz Medicare Advantage |
$21,334.20
|
| Rate for Payer: The Alliance Commercial |
$142,228.00
|
| Rate for Payer: WEA Trust Commercial |
$19,556.35
|
| Rate for Payer: WPS Commercial |
$26,337.07
|
|
|
CUFF WITH IZ AMS 800 6.0CM 72404134
|
Facility
|
OP
|
$37,153.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
5563283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,402.84 |
| Max. Negotiated Rate |
$148,612.00 |
| Rate for Payer: Aetna Commercial |
$33,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,951.58
|
| Rate for Payer: Aetna Managed Medicare |
$10,402.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,149.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,576.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,833.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,691.09
|
| Rate for Payer: Cash Price |
$11,145.90
|
| Rate for Payer: Cigna Commercial |
$34,180.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,790.82
|
| Rate for Payer: Health EOS Commercial |
$33,066.17
|
| Rate for Payer: HFN Commercial |
$34,180.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,864.75
|
| Rate for Payer: Multiplan Commercial |
$29,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$22,291.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34,180.76
|
| Rate for Payer: Quartz Beloit One Network |
$18,204.97
|
| Rate for Payer: Quartz Commercial |
$24,149.45
|
| Rate for Payer: Quartz Medicare Advantage |
$22,291.80
|
| Rate for Payer: The Alliance Commercial |
$148,612.00
|
| Rate for Payer: WEA Trust Commercial |
$20,434.15
|
| Rate for Payer: WPS Commercial |
$27,519.23
|
|
|
CUFF WITH IZ AMS 800 6.0CM 72404134
|
Facility
|
IP
|
$37,153.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
5563283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,204.97 |
| Max. Negotiated Rate |
$34,180.76 |
| Rate for Payer: Aetna Commercial |
$33,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,951.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,691.09
|
| Rate for Payer: Cash Price |
$11,145.90
|
| Rate for Payer: Cigna Commercial |
$34,180.76
|
| Rate for Payer: Health EOS Commercial |
$33,066.17
|
| Rate for Payer: HFN Commercial |
$34,180.76
|
| Rate for Payer: Multiplan Commercial |
$29,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$22,291.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34,180.76
|
| Rate for Payer: Quartz Beloit One Network |
$18,204.97
|
| Rate for Payer: Quartz Commercial |
$22,291.80
|
| Rate for Payer: WEA Trust Commercial |
$20,434.15
|
| Rate for Payer: WPS Commercial |
$27,519.23
|
|
|
CUFF WITH IZ AMS 800 6.5CM 72404135
|
Facility
|
OP
|
$35,200.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
6165741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,856.00 |
| Max. Negotiated Rate |
$140,800.00 |
| Rate for Payer: Aetna Commercial |
$31,680.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,272.00
|
| Rate for Payer: Aetna Managed Medicare |
$9,856.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,880.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,600.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,896.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,656.00
|
| Rate for Payer: Cash Price |
$10,560.00
|
| Rate for Payer: Cigna Commercial |
$32,384.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,697.92
|
| Rate for Payer: Health EOS Commercial |
$31,328.00
|
| Rate for Payer: HFN Commercial |
$32,384.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,400.00
|
| Rate for Payer: Multiplan Commercial |
$28,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$21,120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32,384.00
|
| Rate for Payer: Quartz Beloit One Network |
$17,248.00
|
| Rate for Payer: Quartz Commercial |
$22,880.00
|
| Rate for Payer: Quartz Medicare Advantage |
$21,120.00
|
| Rate for Payer: The Alliance Commercial |
$140,800.00
|
| Rate for Payer: WEA Trust Commercial |
$19,360.00
|
| Rate for Payer: WPS Commercial |
$26,072.64
|
|
|
CUFF WITH IZ AMS 800 6.5CM 72404135
|
Facility
|
IP
|
$35,200.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
6165741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,248.00 |
| Max. Negotiated Rate |
$32,384.00 |
| Rate for Payer: Aetna Commercial |
$31,680.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,656.00
|
| Rate for Payer: Cash Price |
$10,560.00
|
| Rate for Payer: Cigna Commercial |
$32,384.00
|
| Rate for Payer: Health EOS Commercial |
$31,328.00
|
| Rate for Payer: HFN Commercial |
$32,384.00
|
| Rate for Payer: Multiplan Commercial |
$28,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$21,120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32,384.00
|
| Rate for Payer: Quartz Beloit One Network |
$17,248.00
|
| Rate for Payer: Quartz Commercial |
$21,120.00
|
| Rate for Payer: WEA Trust Commercial |
$19,360.00
|
| Rate for Payer: WPS Commercial |
$26,072.64
|
|
|
CUFF WITH IZ AMS 800 72404133
|
Facility
|
IP
|
$33,802.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
5385019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,562.98 |
| Max. Negotiated Rate |
$31,097.84 |
| Rate for Payer: Aetna Commercial |
$30,421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,069.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17,915.06
|
| Rate for Payer: Cash Price |
$10,140.60
|
| Rate for Payer: Cigna Commercial |
$31,097.84
|
| Rate for Payer: Health EOS Commercial |
$30,083.78
|
| Rate for Payer: HFN Commercial |
$31,097.84
|
| Rate for Payer: Multiplan Commercial |
$27,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$20,281.20
|
| Rate for Payer: Preferred Network Access Commercial |
$31,097.84
|
| Rate for Payer: Quartz Beloit One Network |
$16,562.98
|
| Rate for Payer: Quartz Commercial |
$20,281.20
|
| Rate for Payer: WEA Trust Commercial |
$18,591.10
|
| Rate for Payer: WPS Commercial |
$25,037.14
|
|
|
CUFF WITH IZ AMS 800 72404133
|
Facility
|
OP
|
$33,802.00
|
|
|
Service Code
|
HCPCS C1815
|
| Hospital Charge Code |
5385019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,464.56 |
| Max. Negotiated Rate |
$135,208.00 |
| Rate for Payer: Aetna Commercial |
$30,421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,069.72
|
| Rate for Payer: Aetna Managed Medicare |
$9,464.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,971.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,901.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,224.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17,915.06
|
| Rate for Payer: Cash Price |
$10,140.60
|
| Rate for Payer: Cigna Commercial |
$31,097.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,915.60
|
| Rate for Payer: Health EOS Commercial |
$30,083.78
|
| Rate for Payer: HFN Commercial |
$31,097.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,351.50
|
| Rate for Payer: Multiplan Commercial |
$27,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$20,281.20
|
| Rate for Payer: Preferred Network Access Commercial |
$31,097.84
|
| Rate for Payer: Quartz Beloit One Network |
$16,562.98
|
| Rate for Payer: Quartz Commercial |
$21,971.30
|
| Rate for Payer: Quartz Medicare Advantage |
$20,281.20
|
| Rate for Payer: The Alliance Commercial |
$135,208.00
|
| Rate for Payer: WEA Trust Commercial |
$18,591.10
|
| Rate for Payer: WPS Commercial |
$25,037.14
|
|
|
CUP REVERS UNI 42/ +2MM LT OFFSET AR-9502-42LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNI 42/ +2MM LT OFFSET AR-9502-42LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNI 42/ +2MM RT OFFSET AR-9502-42RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNI 42/ +2MM RT OFFSET AR-9502-42RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM LT OFFSET AR-9502-36LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM LT OFFSET AR-9502-36LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM RT OFFSET AR-9502-36RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM RT OFFSET AR-9502-36RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP STERILE SPECIMEN 4 OZ 2600SA/DYND30389/DYND30331
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3331520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
CUP STERILE SPECIMEN 4 OZ 2600SA/DYND30389/DYND30331
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3331520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
CUP UNI REVERS 36/ NEUTRAL CTD AR-9502-36CPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP UNI REVERS 36/ NEUTRAL CTD AR-9502-36CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
CUP UNIVERSAL REVERSE CUP - CAP COATED 39/+2MM LT OFFSET AR-9502-39LCPC
|
Facility
|
OP
|
$8,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,457.84 |
| Max. Negotiated Rate |
$35,112.00 |
| Rate for Payer: Aetna Commercial |
$7,900.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,549.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,457.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,705.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,389.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,213.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.34
|
| Rate for Payer: Cash Price |
$2,633.40
|
| Rate for Payer: Cigna Commercial |
$8,075.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,912.17
|
| Rate for Payer: Health EOS Commercial |
$7,812.42
|
| Rate for Payer: HFN Commercial |
$8,075.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,583.50
|
| Rate for Payer: Multiplan Commercial |
$7,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,266.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.22
|
| Rate for Payer: Quartz Commercial |
$5,705.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,266.80
|
| Rate for Payer: The Alliance Commercial |
$35,112.00
|
| Rate for Payer: WEA Trust Commercial |
$4,827.90
|
| Rate for Payer: WPS Commercial |
$6,501.86
|
|
