|
CUFF BLOOD PRESSURE DISP SM ADULT VSOFT-10
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
4509019
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
CUFF BLOOD PRESSURE DISP SM CHILD SOFT-08
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
4509037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$26.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$56.16
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$56.16
|
| Rate for Payer: The Alliance Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
CUFF BLOOD PRESSURE DISP SM CHILD SOFT-08
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
4509037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
CUFF BLOOD PRESSURE DISP THIGH SOFT-13
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
4509024
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
CUFF BLOOD PRESSURE DISP THIGH SOFT-13
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
4509024
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
CUFF TOURNIQUET 12 60707500200"
|
Facility
|
OP
|
$524.00
|
|
| Hospital Charge Code |
2967412
|
|
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 12 60707500200"
|
Facility
|
IP
|
$524.00
|
|
| Hospital Charge Code |
2967412
|
|
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 18 60707500300"
|
Facility
|
OP
|
$544.00
|
|
| Hospital Charge Code |
2967413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.41 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Aetna Commercial |
$509.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.55
|
| Rate for Payer: Aetna Managed Medicare |
$158.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.56
|
| 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: Dean Health DHI/DHP/ASO |
$316.61
|
| Rate for Payer: Health EOS Commercial |
$503.53
|
| Rate for Payer: HFN Commercial |
$520.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.32
|
| Rate for Payer: Multiplan Commercial |
$452.61
|
| Rate for Payer: NAPHCARE Commercial |
$339.46
|
| Rate for Payer: Preferred Network Access Commercial |
$520.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.22
|
| Rate for Payer: Quartz Commercial |
$367.74
|
| Rate for Payer: Quartz Medicare Advantage |
$339.46
|
| Rate for Payer: The Alliance Commercial |
$282.88
|
| Rate for Payer: WEA Trust Commercial |
$311.17
|
| Rate for Payer: WPS Commercial |
$419.04
|
|
|
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
|
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 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 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
|
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 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 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 6.0CM 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 6.5CM 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 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 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
|
|
|
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
|
|
|
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates
|
Facility
|
OP
|
$35.86
|
|
|
Service Code
|
CPT 87070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
|
|
Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates
|
Facility
|
OP
|
$39.40
|
|
|
Service Code
|
CPT 87075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$39.40 |
| Rate for Payer: Aetna Managed Medicare |
$9.85
|
| Rate for Payer: Anthem Medicare Advantage |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.85
|
| Rate for Payer: NAPHCARE Commercial |
$14.77
|
| Rate for Payer: Quartz Medicare Advantage |
$9.85
|
| Rate for Payer: The Alliance Commercial |
$39.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.85
|
| Rate for Payer: Wellcare Medicare |
$9.85
|
|
