|
ELECTRODE 20/15MM LOOP DLP-L11
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2967377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 20/15MM LOOP DLP-L11
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2967377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 24FR CUT LOOP A22201C
|
Facility
|
OP
|
$1,305.00
|
|
| Hospital Charge Code |
2965438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.02 |
| Max. Negotiated Rate |
$1,248.62 |
| Rate for Payer: Aetna Commercial |
$1,221.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.19
|
| Rate for Payer: Aetna Managed Medicare |
$380.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$678.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.32
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,248.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.51
|
| Rate for Payer: Health EOS Commercial |
$1,207.91
|
| Rate for Payer: HFN Commercial |
$1,248.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,017.90
|
| Rate for Payer: Multiplan Commercial |
$1,085.76
|
| Rate for Payer: NAPHCARE Commercial |
$814.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.62
|
| Rate for Payer: Quartz Beloit One Network |
$665.03
|
| Rate for Payer: Quartz Commercial |
$882.18
|
| Rate for Payer: Quartz Medicare Advantage |
$814.32
|
| Rate for Payer: The Alliance Commercial |
$678.60
|
| Rate for Payer: WEA Trust Commercial |
$746.46
|
| Rate for Payer: WPS Commercial |
$1,005.24
|
|
|
ELECTRODE 24FR CUT LOOP A22201C
|
Facility
|
IP
|
$1,305.00
|
|
| Hospital Charge Code |
2965438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.03 |
| Max. Negotiated Rate |
$1,248.62 |
| Rate for Payer: Aetna Commercial |
$1,221.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.32
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,248.62
|
| Rate for Payer: Health EOS Commercial |
$1,207.91
|
| Rate for Payer: HFN Commercial |
$1,248.62
|
| Rate for Payer: Multiplan Commercial |
$1,085.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.62
|
| Rate for Payer: Quartz Beloit One Network |
$665.03
|
| Rate for Payer: Quartz Commercial |
$814.32
|
| Rate for Payer: WEA Trust Commercial |
$746.46
|
| Rate for Payer: WPS Commercial |
$1,005.24
|
|
|
ELECTRODE 3M RED DOT EKG FOAM 2560
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
2970156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ELECTRODE 3M RED DOT EKG FOAM 2560
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
2970156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ELECTRODE ACROMIOPLASTY 9801BA
|
Facility
|
OP
|
$1,104.00
|
|
| Hospital Charge Code |
2964916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.48 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$321.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.53
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: Quartz Medicare Advantage |
$688.90
|
| Rate for Payer: The Alliance Commercial |
$574.08
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
ELECTRODE ACROMIOPLASTY 9801BA
|
Facility
|
IP
|
$1,104.00
|
|
| Hospital Charge Code |
2964916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$688.90
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
Electrode,Adlt.Defib,Lifepak12
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
3040333
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Electrode,Adlt.Defib,Lifepak12
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
3040333
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
ELECTRODE BALL 3MM LE-13-003
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2965283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE BALL 3MM LE-13-003
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2965283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE BALL 5MM LE-14-005/ 028042
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2965284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE BALL 5MM LE-14-005/ 028042
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2965284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE BIS QUATRO SENSOR 186-0106
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
2969221
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
ELECTRODE BIS QUATRO SENSOR 186-0106
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
2969221
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Electrode (In 3s)
|
Facility
|
OP
|
$67.00
|
|
| Hospital Charge Code |
3101747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.26
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$41.81
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$41.81
|
| Rate for Payer: The Alliance Commercial |
$34.84
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Electrode (In 3s)
|
Facility
|
IP
|
$67.00
|
|
| Hospital Charge Code |
3101747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
ELECTRODE INFANT/CHILD LP1000 /AED ONLY 11101-000016
|
Facility
|
OP
|
$1,655.00
|
|
| Hospital Charge Code |
2963294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$481.94 |
| Max. Negotiated Rate |
$1,583.50 |
| Rate for Payer: Aetna Commercial |
$1,549.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,480.23
|
| Rate for Payer: Aetna Managed Medicare |
$481.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,118.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$860.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$826.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$912.24
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,583.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$963.21
|
| Rate for Payer: Health EOS Commercial |
$1,531.87
|
| Rate for Payer: HFN Commercial |
$1,583.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,290.90
|
| Rate for Payer: Multiplan Commercial |
$1,376.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,032.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.50
|
| Rate for Payer: Quartz Beloit One Network |
$843.39
|
| Rate for Payer: Quartz Commercial |
$1,118.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,032.72
|
| Rate for Payer: The Alliance Commercial |
$860.60
|
| Rate for Payer: WEA Trust Commercial |
$946.66
|
| Rate for Payer: WPS Commercial |
$1,274.85
|
|
|
ELECTRODE INFANT/CHILD LP1000 /AED ONLY 11101-000016
|
Facility
|
IP
|
$1,655.00
|
|
| Hospital Charge Code |
2963294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.39 |
| Max. Negotiated Rate |
$1,583.50 |
| Rate for Payer: Aetna Commercial |
$1,549.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,480.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$912.24
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,583.50
|
| Rate for Payer: Health EOS Commercial |
$1,531.87
|
| Rate for Payer: HFN Commercial |
$1,583.50
|
| Rate for Payer: Multiplan Commercial |
$1,376.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.50
|
| Rate for Payer: Quartz Beloit One Network |
$843.39
|
| Rate for Payer: Quartz Commercial |
$1,032.72
|
| Rate for Payer: WEA Trust Commercial |
$946.66
|
| Rate for Payer: WPS Commercial |
$1,274.85
|
|
|
Electrode Infant Pregel
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Electrode Infant Pregel
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
ELECTRODE L-HOOK LAPAROSCOPIC E3774-36C
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
2965848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.23 |
| Max. Negotiated Rate |
$770.22 |
| Rate for Payer: Aetna Commercial |
$753.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.72
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$770.22
|
| Rate for Payer: Health EOS Commercial |
$745.11
|
| Rate for Payer: HFN Commercial |
$770.22
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Preferred Network Access Commercial |
$770.22
|
| Rate for Payer: Quartz Beloit One Network |
$410.23
|
| Rate for Payer: Quartz Commercial |
$502.32
|
| Rate for Payer: WEA Trust Commercial |
$460.46
|
| Rate for Payer: WPS Commercial |
$620.09
|
|
|
ELECTRODE L-HOOK LAPAROSCOPIC E3774-36C
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
2965848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$770.22 |
| Rate for Payer: Aetna Commercial |
$753.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.99
|
| Rate for Payer: Aetna Managed Medicare |
$234.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$544.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$401.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.72
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$770.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.51
|
| Rate for Payer: Health EOS Commercial |
$745.11
|
| Rate for Payer: HFN Commercial |
$770.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: NAPHCARE Commercial |
$502.32
|
| Rate for Payer: Preferred Network Access Commercial |
$770.22
|
| Rate for Payer: Quartz Beloit One Network |
$410.23
|
| Rate for Payer: Quartz Commercial |
$544.18
|
| Rate for Payer: Quartz Medicare Advantage |
$502.32
|
| Rate for Payer: The Alliance Commercial |
$418.60
|
| Rate for Payer: WEA Trust Commercial |
$460.46
|
| Rate for Payer: WPS Commercial |
$620.09
|
|
|
Electrode Monitoring 5'S
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
