|
Sensipar 60 mg per tablet
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Sensipar 90 mg per dose
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Sensipar 90 mg per dose
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Sensipar 90 mg per tablet
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Sensipar 90 mg per tablet
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
SENSOR ADLT DISPOSABLE NELLCOR
|
Facility
|
IP
|
$346.00
|
|
| Hospital Charge Code |
2969074
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
SENSOR ADLT DISPOSABLE NELLCOR
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
2969074
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$96.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.62
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$207.60
|
| Rate for Payer: The Alliance Commercial |
$1,384.00
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
SENSOR ADULT DISPOSABLE 1.5 1859
|
Facility
|
IP
|
$258.00
|
|
| Hospital Charge Code |
2963039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
SENSOR ADULT DISPOSABLE 1.5 1859
|
Facility
|
OP
|
$258.00
|
|
| Hospital Charge Code |
2963039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: The Alliance Commercial |
$1,032.00
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
SENSOR INFANT DISPOSABLE 2328
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2963000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SENSOR INFANT DISPOSABLE 2328
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2963000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SENSOR MASIMO 03 REGIONAL LARGE 3756
|
Facility
|
IP
|
$1,353.00
|
|
| Hospital Charge Code |
5107035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$662.97 |
| Max. Negotiated Rate |
$1,244.76 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$811.80
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
SENSOR MASIMO 03 REGIONAL LARGE 3756
|
Facility
|
OP
|
$1,353.00
|
|
| Hospital Charge Code |
5107035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.84 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Aetna Managed Medicare |
$378.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$879.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.14
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,014.75
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$879.45
|
| Rate for Payer: Quartz Medicare Advantage |
$811.80
|
| Rate for Payer: The Alliance Commercial |
$5,412.00
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
SENSOR NEO/ADLT DISPBL NELLCOR
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS A4606
|
| Hospital Charge Code |
2962921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
SENSOR NEO/ADLT DISPBL NELLCOR
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS A4606
|
| Hospital Charge Code |
2962921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
SENSOR NEONATAL DISPOSABL 2329
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2962999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SENSOR NEONATAL DISPOSABL 2329
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2962999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
SENSOR PAD BED SITTER II BED
|
Facility
|
OP
|
$478.00
|
|
| Hospital Charge Code |
2963767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$133.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.50
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| Rate for Payer: Quartz Medicare Advantage |
$286.80
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SENSOR PAD BED SITTER II BED
|
Facility
|
IP
|
$478.00
|
|
| Hospital Charge Code |
2963767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SENSOR PAD SITTER II CHAIR ALARM 8309EL
|
Facility
|
OP
|
$582.00
|
|
| Hospital Charge Code |
2963691
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$162.96 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Aetna Managed Medicare |
$162.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.69
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.50
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$378.30
|
| Rate for Payer: Quartz Medicare Advantage |
$349.20
|
| Rate for Payer: The Alliance Commercial |
$2,328.00
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
SENSOR PAD SITTER II CHAIR ALARM 8309EL
|
Facility
|
IP
|
$582.00
|
|
| Hospital Charge Code |
2963691
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$285.18 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
SENSOR PEDIATRIC DISP
|
Facility
|
IP
|
$272.00
|
|
| Hospital Charge Code |
2963038
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
SENSOR PEDIATRIC DISP
|
Facility
|
OP
|
$272.00
|
|
| Hospital Charge Code |
2963038
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$76.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$163.20
|
| Rate for Payer: The Alliance Commercial |
$1,088.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Sensory Integration/15 Min Charges
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 97533 GP
|
| Hospital Charge Code |
2564915
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Aetna Managed Medicare |
$78.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.25
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$182.65
|
| Rate for Payer: Quartz Medicare Advantage |
$168.60
|
| Rate for Payer: The Alliance Commercial |
$1,124.00
|
| Rate for Payer: United Healthcare PPO |
$210.75
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Sensory Integration/15 Min Charges
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 97533 GP
|
| Hospital Charge Code |
2564915
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$258.52 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$168.60
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
