|
CUFF TOURNIQUET 18 60707500300"
|
Facility
|
IP
|
$544.00
|
|
| Hospital Charge Code |
2967413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.22 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Aetna Commercial |
$509.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.85
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$520.50
|
| Rate for Payer: Health EOS Commercial |
$503.53
|
| Rate for Payer: HFN Commercial |
$520.50
|
| Rate for Payer: Multiplan Commercial |
$452.61
|
| Rate for Payer: Preferred Network Access Commercial |
$520.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.22
|
| Rate for Payer: Quartz Commercial |
$339.46
|
| Rate for Payer: WEA Trust Commercial |
$311.17
|
| Rate for Payer: WPS Commercial |
$419.04
|
|
|
CUFF TOURNIQUET 24 60707500400"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$501.36 |
| Rate for Payer: Aetna Commercial |
$490.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.67
|
| Rate for Payer: Aetna Managed Medicare |
$152.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$272.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.83
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$501.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.97
|
| Rate for Payer: Health EOS Commercial |
$485.01
|
| Rate for Payer: HFN Commercial |
$501.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.72
|
| Rate for Payer: Multiplan Commercial |
$435.97
|
| Rate for Payer: NAPHCARE Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$501.36
|
| Rate for Payer: Quartz Beloit One Network |
$267.03
|
| Rate for Payer: Quartz Commercial |
$354.22
|
| Rate for Payer: Quartz Medicare Advantage |
$326.98
|
| Rate for Payer: The Alliance Commercial |
$272.48
|
| Rate for Payer: WEA Trust Commercial |
$299.73
|
| Rate for Payer: WPS Commercial |
$403.64
|
|
|
CUFF TOURNIQUET 24 60707500400"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.03 |
| Max. Negotiated Rate |
$501.36 |
| Rate for Payer: Aetna Commercial |
$490.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.83
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$501.36
|
| Rate for Payer: Health EOS Commercial |
$485.01
|
| Rate for Payer: HFN Commercial |
$501.36
|
| Rate for Payer: Multiplan Commercial |
$435.97
|
| Rate for Payer: Preferred Network Access Commercial |
$501.36
|
| Rate for Payer: Quartz Beloit One Network |
$267.03
|
| Rate for Payer: Quartz Commercial |
$326.98
|
| Rate for Payer: WEA Trust Commercial |
$299.73
|
| Rate for Payer: WPS Commercial |
$403.64
|
|
|
CUFF TOURNIQUET 34 60707500600"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$501.36 |
| Rate for Payer: Aetna Commercial |
$490.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.67
|
| Rate for Payer: Aetna Managed Medicare |
$152.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$272.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.83
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$501.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.97
|
| Rate for Payer: Health EOS Commercial |
$485.01
|
| Rate for Payer: HFN Commercial |
$501.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.72
|
| Rate for Payer: Multiplan Commercial |
$435.97
|
| Rate for Payer: NAPHCARE Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$501.36
|
| Rate for Payer: Quartz Beloit One Network |
$267.03
|
| Rate for Payer: Quartz Commercial |
$354.22
|
| Rate for Payer: Quartz Medicare Advantage |
$326.98
|
| Rate for Payer: The Alliance Commercial |
$272.48
|
| Rate for Payer: WEA Trust Commercial |
$299.73
|
| Rate for Payer: WPS Commercial |
$403.64
|
|
|
CUFF TOURNIQUET 34 60707500600"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.03 |
| Max. Negotiated Rate |
$501.36 |
| Rate for Payer: Aetna Commercial |
$490.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.83
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$501.36
|
| Rate for Payer: Health EOS Commercial |
$485.01
|
| Rate for Payer: HFN Commercial |
$501.36
|
| Rate for Payer: Multiplan Commercial |
$435.97
|
| Rate for Payer: Preferred Network Access Commercial |
$501.36
|
| Rate for Payer: Quartz Beloit One Network |
$267.03
|
| Rate for Payer: Quartz Commercial |
$326.98
|
| Rate for Payer: WEA Trust Commercial |
$299.73
|
| Rate for Payer: WPS Commercial |
$403.64
|
|
|
CUFF TOURNIQUET 42 60707500700"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.59 |
| Max. Negotiated Rate |
$501.36 |
| Rate for Payer: Aetna Commercial |
$490.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.67
|
| Rate for Payer: Aetna Managed Medicare |
$152.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$272.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.83
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$501.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.97
|
| Rate for Payer: Health EOS Commercial |
$485.01
|
| Rate for Payer: HFN Commercial |
$501.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.72
|
| Rate for Payer: Multiplan Commercial |
$435.97
|
| Rate for Payer: NAPHCARE Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$501.36
|
| Rate for Payer: Quartz Beloit One Network |
$267.03
|
| Rate for Payer: Quartz Commercial |
$354.22
|
| Rate for Payer: Quartz Medicare Advantage |
$326.98
|
| Rate for Payer: The Alliance Commercial |
$272.48
|
| Rate for Payer: WEA Trust Commercial |
$299.73
|
| Rate for Payer: WPS Commercial |
$403.64
|
|
|
CUFF TOURNIQUET 42 60707500700"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.03 |
| Max. Negotiated Rate |
$501.36 |
| Rate for Payer: Aetna Commercial |
$490.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.83
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$501.36
|
| Rate for Payer: Health EOS Commercial |
$485.01
|
| Rate for Payer: HFN Commercial |
$501.36
|
| Rate for Payer: Multiplan Commercial |
$435.97
|
| Rate for Payer: Preferred Network Access Commercial |
$501.36
|
| Rate for Payer: Quartz Beloit One Network |
$267.03
|
| Rate for Payer: Quartz Commercial |
$326.98
|
| Rate for Payer: WEA Trust Commercial |
$299.73
|
| Rate for Payer: WPS Commercial |
$403.64
|
|
|
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 |
$10,354.20 |
| Max. Negotiated Rate |
$34,020.94 |
| Rate for Payer: Aetna Commercial |
$33,281.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,802.18
|
| Rate for Payer: Aetna Managed Medicare |
$10,354.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,036.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,489.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,750.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,599.02
|
| Rate for Payer: Cash Price |
$10,667.10
|
| Rate for Payer: Cigna Commercial |
$34,020.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,694.17
|
| Rate for Payer: Health EOS Commercial |
$32,911.56
|
| Rate for Payer: HFN Commercial |
$34,020.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,734.46
|
| Rate for Payer: Multiplan Commercial |
$29,583.42
|
| Rate for Payer: NAPHCARE Commercial |
$22,187.57
|
| Rate for Payer: Preferred Network Access Commercial |
$34,020.94
|
| Rate for Payer: Quartz Beloit One Network |
$18,119.85
|
| Rate for Payer: Quartz Commercial |
$24,036.53
|
| Rate for Payer: Quartz Medicare Advantage |
$22,187.57
|
| Rate for Payer: The Alliance Commercial |
$18,489.64
|
| Rate for Payer: WEA Trust Commercial |
$20,338.60
|
| Rate for Payer: WPS Commercial |
$27,389.56
|
|
|
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 |
$18,119.85 |
| Max. Negotiated Rate |
$34,020.94 |
| Rate for Payer: Aetna Commercial |
$33,281.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,802.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,599.02
|
| Rate for Payer: Cash Price |
$10,667.10
|
| Rate for Payer: Cigna Commercial |
$34,020.94
|
| Rate for Payer: Health EOS Commercial |
$32,911.56
|
| Rate for Payer: HFN Commercial |
$34,020.94
|
| Rate for Payer: Multiplan Commercial |
$29,583.42
|
| Rate for Payer: Preferred Network Access Commercial |
$34,020.94
|
| Rate for Payer: Quartz Beloit One Network |
$18,119.85
|
| Rate for Payer: Quartz Commercial |
$22,187.57
|
| Rate for Payer: WEA Trust Commercial |
$20,338.60
|
| Rate for Payer: WPS Commercial |
$27,389.56
|
|
|
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 |
$18,933.17 |
| Max. Negotiated Rate |
$35,547.99 |
| Rate for Payer: Aetna Commercial |
$34,775.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,229.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,478.73
|
| Rate for Payer: Cash Price |
$11,145.90
|
| Rate for Payer: Cigna Commercial |
$35,547.99
|
| Rate for Payer: Health EOS Commercial |
$34,388.82
|
| Rate for Payer: HFN Commercial |
$35,547.99
|
| Rate for Payer: Multiplan Commercial |
$30,911.30
|
| Rate for Payer: Preferred Network Access Commercial |
$35,547.99
|
| Rate for Payer: Quartz Beloit One Network |
$18,933.17
|
| Rate for Payer: Quartz Commercial |
$23,183.47
|
| Rate for Payer: WEA Trust Commercial |
$21,251.52
|
| Rate for Payer: WPS Commercial |
$28,618.96
|
|
|
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 |
$10,818.95 |
| Max. Negotiated Rate |
$35,547.99 |
| Rate for Payer: Aetna Commercial |
$34,775.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,229.64
|
| Rate for Payer: Aetna Managed Medicare |
$10,818.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,115.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,319.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,546.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,478.73
|
| Rate for Payer: Cash Price |
$11,145.90
|
| Rate for Payer: Cigna Commercial |
$35,547.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,623.05
|
| Rate for Payer: Health EOS Commercial |
$34,388.82
|
| Rate for Payer: HFN Commercial |
$35,547.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,979.34
|
| Rate for Payer: Multiplan Commercial |
$30,911.30
|
| Rate for Payer: NAPHCARE Commercial |
$23,183.47
|
| Rate for Payer: Preferred Network Access Commercial |
$35,547.99
|
| Rate for Payer: Quartz Beloit One Network |
$18,933.17
|
| Rate for Payer: Quartz Commercial |
$25,115.43
|
| Rate for Payer: Quartz Medicare Advantage |
$23,183.47
|
| Rate for Payer: The Alliance Commercial |
$19,319.56
|
| Rate for Payer: WEA Trust Commercial |
$21,251.52
|
| Rate for Payer: WPS Commercial |
$28,618.96
|
|
|
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 |
$10,250.24 |
| Max. Negotiated Rate |
$33,679.36 |
| Rate for Payer: Aetna Commercial |
$32,947.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,482.88
|
| Rate for Payer: Aetna Managed Medicare |
$10,250.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,795.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,571.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,402.24
|
| Rate for Payer: Cash Price |
$10,560.00
|
| Rate for Payer: Cigna Commercial |
$33,679.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,486.40
|
| Rate for Payer: Health EOS Commercial |
$32,581.12
|
| Rate for Payer: HFN Commercial |
$33,679.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,456.00
|
| Rate for Payer: Multiplan Commercial |
$29,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$21,964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$33,679.36
|
| Rate for Payer: Quartz Beloit One Network |
$17,937.92
|
| Rate for Payer: Quartz Commercial |
$23,795.20
|
| Rate for Payer: Quartz Medicare Advantage |
$21,964.80
|
| Rate for Payer: The Alliance Commercial |
$18,304.00
|
| Rate for Payer: WEA Trust Commercial |
$20,134.40
|
| Rate for Payer: WPS Commercial |
$27,114.56
|
|
|
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 |
$17,937.92 |
| Max. Negotiated Rate |
$33,679.36 |
| Rate for Payer: Aetna Commercial |
$32,947.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,402.24
|
| Rate for Payer: Cash Price |
$10,560.00
|
| Rate for Payer: Cigna Commercial |
$33,679.36
|
| Rate for Payer: Health EOS Commercial |
$32,581.12
|
| Rate for Payer: HFN Commercial |
$33,679.36
|
| Rate for Payer: Multiplan Commercial |
$29,286.40
|
| Rate for Payer: Preferred Network Access Commercial |
$33,679.36
|
| Rate for Payer: Quartz Beloit One Network |
$17,937.92
|
| Rate for Payer: Quartz Commercial |
$21,964.80
|
| Rate for Payer: WEA Trust Commercial |
$20,134.40
|
| Rate for Payer: WPS Commercial |
$27,114.56
|
|
|
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 |
$17,225.50 |
| Max. Negotiated Rate |
$32,341.75 |
| Rate for Payer: Aetna Commercial |
$31,638.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,232.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,631.66
|
| Rate for Payer: Cash Price |
$10,140.60
|
| Rate for Payer: Cigna Commercial |
$32,341.75
|
| Rate for Payer: Health EOS Commercial |
$31,287.13
|
| Rate for Payer: HFN Commercial |
$32,341.75
|
| Rate for Payer: Multiplan Commercial |
$28,123.26
|
| Rate for Payer: Preferred Network Access Commercial |
$32,341.75
|
| Rate for Payer: Quartz Beloit One Network |
$17,225.50
|
| Rate for Payer: Quartz Commercial |
$21,092.45
|
| Rate for Payer: WEA Trust Commercial |
$19,334.74
|
| Rate for Payer: WPS Commercial |
$26,037.68
|
|
|
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 |
$9,843.14 |
| Max. Negotiated Rate |
$32,341.75 |
| Rate for Payer: Aetna Commercial |
$31,638.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,232.51
|
| Rate for Payer: Aetna Managed Medicare |
$9,843.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,850.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,577.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,873.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,631.66
|
| Rate for Payer: Cash Price |
$10,140.60
|
| Rate for Payer: Cigna Commercial |
$32,341.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,672.76
|
| Rate for Payer: Health EOS Commercial |
$31,287.13
|
| Rate for Payer: HFN Commercial |
$32,341.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,365.56
|
| Rate for Payer: Multiplan Commercial |
$28,123.26
|
| Rate for Payer: NAPHCARE Commercial |
$21,092.45
|
| Rate for Payer: Preferred Network Access Commercial |
$32,341.75
|
| Rate for Payer: Quartz Beloit One Network |
$17,225.50
|
| Rate for Payer: Quartz Commercial |
$22,850.15
|
| Rate for Payer: Quartz Medicare Advantage |
$21,092.45
|
| Rate for Payer: The Alliance Commercial |
$17,577.04
|
| Rate for Payer: WEA Trust Commercial |
$19,334.74
|
| Rate for Payer: WPS Commercial |
$26,037.68
|
|
|
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 |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP STERILE SPECIMEN 4 OZ 2600SA/DYND30389/DYND30331
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3331520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
CUP STERILE SPECIMEN 4 OZ 2600SA/DYND30389/DYND30331
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3331520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
