|
COVERALL HOODED W/BOOTS XL45094
|
Facility
OP
|
$265.00
|
|
| Hospital Charge Code |
4347542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$74.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$159.00
|
| Rate for Payer: The Alliance Commercial |
$1,060.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
COVERALL TYVEK 2 XL 76827
|
Facility
OP
|
$212.00
|
|
| Hospital Charge Code |
4494607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.36 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$59.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$127.20
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
COVERALL TYVEK 2 XL 76827
|
Facility
IP
|
$212.00
|
|
| Hospital Charge Code |
4494607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
COVERALL TYVEK XL 76830
|
Facility
IP
|
$191.00
|
|
| Hospital Charge Code |
4493675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
COVERALL TYVEK XL 76830
|
Facility
OP
|
$191.00
|
|
| Hospital Charge Code |
4493675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$53.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$114.60
|
| Rate for Payer: The Alliance Commercial |
$764.00
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
COVER BACK TABLE 88 X 44 42301
|
Facility
IP
|
$106.00
|
|
| Hospital Charge Code |
2963488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
COVER BACK TABLE 88 X 44 42301
|
Facility
OP
|
$106.00
|
|
| Hospital Charge Code |
2963488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$29.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$63.60
|
| Rate for Payer: The Alliance Commercial |
$424.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
COVER LARGE MAYO 30 X 57 89602
|
Facility
OP
|
$87.00
|
|
| Hospital Charge Code |
2963386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
COVER LARGE MAYO 30 X 57 89602
|
Facility
IP
|
$87.00
|
|
| Hospital Charge Code |
2963386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
COVERLET 4-WING 3x3 #00385
|
Facility
OP
|
$85.00
|
|
| Hospital Charge Code |
2974298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
COVERLET 4-WING 3x3 #00385
|
Facility
IP
|
$85.00
|
|
| Hospital Charge Code |
2974298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
COVER LIGHT HANDLE RIGID DYNJLHH1
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
5179131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
COVER LIGHT HANDLE RIGID DYNJLHH1
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
5179131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
COVER OVERHEAD TABLE STERILE 89621
|
Facility
IP
|
$237.00
|
|
| Hospital Charge Code |
5264613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$142.20
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
COVER OVERHEAD TABLE STERILE 89621
|
Facility
OP
|
$237.00
|
|
| Hospital Charge Code |
5264613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.36 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Aetna Managed Medicare |
$66.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$118.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.63
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.75
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$154.05
|
| Rate for Payer: Quartz Medicare Advantage |
$142.20
|
| Rate for Payer: The Alliance Commercial |
$948.00
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
COVER PROBE 6X96 PC1292NG"
|
Facility
IP
|
$289.00
|
|
| Hospital Charge Code |
2963032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$265.88 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$173.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$173.40
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
|
COVER PROBE 6X96 PC1292NG"
|
Facility
OP
|
$289.00
|
|
| Hospital Charge Code |
2963032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Aetna Managed Medicare |
$80.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.72
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.75
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$173.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$187.85
|
| Rate for Payer: Quartz Medicare Advantage |
$173.40
|
| Rate for Payer: The Alliance Commercial |
$1,156.00
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
|
COVER PROBE ULTRASOUND 6 X 96 PC-6X96
|
Facility
IP
|
$282.00
|
|
| Hospital Charge Code |
4399657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$259.44 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$259.44
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$169.20
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$169.20
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
COVER PROBE ULTRASOUND 6 X 96 PC-6X96
|
Facility
OP
|
$282.00
|
|
| Hospital Charge Code |
4399657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Aetna Managed Medicare |
$78.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$259.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.81
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$169.20
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$183.30
|
| Rate for Payer: Quartz Medicare Advantage |
$169.20
|
| Rate for Payer: The Alliance Commercial |
$1,128.00
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
COVER TRANSDUCER STERILE 610575
|
Facility
OP
|
$264.00
|
|
| Hospital Charge Code |
2970214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Aetna Managed Medicare |
$73.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.73
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$158.40
|
| Rate for Payer: The Alliance Commercial |
$1,056.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
COVER TRANSDUCER STERILE 610575
|
Facility
IP
|
$264.00
|
|
| Hospital Charge Code |
2970214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$158.40
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
COVID-19, Antibody IgG Quantitative
|
Professional
|
$292.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
5711633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna Commercial |
$277.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$42.13
|
| Rate for Payer: Anthem Medicare Advantage |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.13
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$277.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.13
|
| Rate for Payer: Health EOS Commercial |
$265.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.13
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$277.40
|
| Rate for Payer: Quartz Beloit One Network |
$128.48
|
| Rate for Payer: Quartz Commercial |
$166.44
|
| Rate for Payer: Quartz Medicare Advantage |
$42.13
|
| Rate for Payer: The Alliance Commercial |
$166.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$185.37
|
|
|
COVID-19, Antibody IgG Quantitative
|
Facility
OP
|
$292.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
5711633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$42.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.94
|
| Rate for Payer: Anthem Medicaid |
$42.13
|
| Rate for Payer: Anthem Medicare Advantage |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.13
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.13
|
| Rate for Payer: Dean Health Medicaid |
$42.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.13
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.13
|
| Rate for Payer: Managed Health Services Medicaid |
$43.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.13
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$42.13
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$42.13
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: United Healthcare PPO |
$219.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: Wellcare Medicare |
$42.13
|
| Rate for Payer: WMAP Medicaid |
$42.13
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
COVID-19, Antibody IgG Quantitative
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
5711633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
COVID-19, Antigen at BMH
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
5637624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$35.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.65
|
| Rate for Payer: Anthem Medicaid |
$35.33
|
| Rate for Payer: Anthem Medicare Advantage |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.33
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.33
|
| Rate for Payer: Dean Health Medicaid |
$35.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.33
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.33
|
| Rate for Payer: Managed Health Services Medicaid |
$36.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.33
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$53.00
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.33
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$35.33
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: United Healthcare Medicaid |
$35.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: Wellcare Medicare |
$35.33
|
| Rate for Payer: WMAP Medicaid |
$35.33
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
