|
COUPLING ROD-TO-ROD 5.0/3.0MM 4960-1-060
|
Facility
|
IP
|
$3,806.00
|
|
| Hospital Charge Code |
6170222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,939.54 |
| Max. Negotiated Rate |
$3,641.58 |
| Rate for Payer: Aetna Commercial |
$3,562.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,404.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,097.87
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,641.58
|
| Rate for Payer: Health EOS Commercial |
$3,522.83
|
| Rate for Payer: HFN Commercial |
$3,641.58
|
| Rate for Payer: Multiplan Commercial |
$3,166.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,641.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,939.54
|
| Rate for Payer: Quartz Commercial |
$2,374.94
|
| Rate for Payer: WEA Trust Commercial |
$2,177.03
|
| Rate for Payer: WPS Commercial |
$2,931.76
|
|
|
COUPLING ROD-TO-ROD 5.0/3.0MM 4960-1-060
|
Facility
|
OP
|
$3,806.00
|
|
| Hospital Charge Code |
6170222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,108.31 |
| Max. Negotiated Rate |
$3,641.58 |
| Rate for Payer: Aetna Commercial |
$3,562.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,404.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,572.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,979.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,899.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,097.87
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,641.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,215.09
|
| Rate for Payer: Health EOS Commercial |
$3,522.83
|
| Rate for Payer: HFN Commercial |
$3,641.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,968.68
|
| Rate for Payer: Multiplan Commercial |
$3,166.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,641.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,939.54
|
| Rate for Payer: Quartz Commercial |
$2,572.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,374.94
|
| Rate for Payer: The Alliance Commercial |
$1,979.12
|
| Rate for Payer: WEA Trust Commercial |
$2,177.03
|
| Rate for Payer: WPS Commercial |
$2,931.76
|
|
|
COVERALL HOODED W/BOOTS 2XL 45095
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
4347543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL HOODED W/BOOTS 2XL 45095
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
4347543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$77.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.70
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$165.36
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$165.36
|
| Rate for Payer: The Alliance Commercial |
$137.80
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL HOODED W/BOOTS XL45094
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
4347542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$77.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.70
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$165.36
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$165.36
|
| Rate for Payer: The Alliance Commercial |
$137.80
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL HOODED W/BOOTS XL45094
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
4347542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL TYVEK 2 XL 76827
|
Facility
|
OP
|
$212.00
|
|
| Hospital Charge Code |
4494607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$61.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$132.29
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
COVERALL TYVEK 2 XL 76827
|
Facility
|
IP
|
$212.00
|
|
| Hospital Charge Code |
4494607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
COVERALL TYVEK XL 76830
|
Facility
|
OP
|
$191.00
|
|
| Hospital Charge Code |
4493675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$55.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.98
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$119.18
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$119.18
|
| Rate for Payer: The Alliance Commercial |
$99.32
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
COVERALL TYVEK XL 76830
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
4493675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
COVER BACK TABLE 88 X 44 42301
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
2963488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
COVER BACK TABLE 88 X 44 42301
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
2963488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
COVER LARGE MAYO 30 X 57 89602
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2963386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
COVER LARGE MAYO 30 X 57 89602
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2963386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
COVERLET 4-WING 3x3 #00385
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2974298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
COVERLET 4-WING 3x3 #00385
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2974298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
COVER LIGHT HANDLE RIGID DYNJLHH1
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
5179131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
COVER LIGHT HANDLE RIGID DYNJLHH1
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
5179131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
COVER OVERHEAD TABLE STERILE 89621
|
Facility
|
IP
|
$237.00
|
|
| Hospital Charge Code |
5264613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
COVER OVERHEAD TABLE STERILE 89621
|
Facility
|
OP
|
$237.00
|
|
| Hospital Charge Code |
5264613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: The Alliance Commercial |
$123.24
|
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$69.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.86
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$147.89
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$160.21
|
| Rate for Payer: Quartz Medicare Advantage |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
COVER PROBE 6X96 PC1292NG"
|
Facility
|
IP
|
$289.00
|
|
| Hospital Charge Code |
2963032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$180.34
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
COVER PROBE 6X96 PC1292NG"
|
Facility
|
OP
|
$289.00
|
|
| Hospital Charge Code |
2963032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.16 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$84.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.20
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.42
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$180.34
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$195.36
|
| Rate for Payer: Quartz Medicare Advantage |
$180.34
|
| Rate for Payer: The Alliance Commercial |
$150.28
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
COVER PROBE ULTRASOUND 6 X 96 PC-6X96
|
Facility
|
OP
|
$282.00
|
|
| Hospital Charge Code |
4399657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.12 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$82.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.12
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.96
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$175.97
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$190.63
|
| Rate for Payer: Quartz Medicare Advantage |
$175.97
|
| Rate for Payer: The Alliance Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
COVER PROBE ULTRASOUND 6 X 96 PC-6X96
|
Facility
|
IP
|
$282.00
|
|
| Hospital Charge Code |
4399657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$175.97
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
COVER TRANSDUCER STERILE 610575
|
Facility
|
IP
|
$264.00
|
|
| Hospital Charge Code |
2970214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.52
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$252.60
|
| Rate for Payer: Health EOS Commercial |
$244.36
|
| Rate for Payer: HFN Commercial |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: Preferred Network Access Commercial |
$252.60
|
| Rate for Payer: Quartz Beloit One Network |
$134.53
|
| Rate for Payer: Quartz Commercial |
$164.74
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
