|
Electrode Monitoring 5'S
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040331
|
|
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 NEEDLE E1552
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2963049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
ELECTRODE NEEDLE E1552
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2963049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
ELECTRODE OLYMPUS HF RESECTION 45DEG NEEDLE TUIP/COLLINS KNIFE A22255C
|
Facility
|
OP
|
$1,713.00
|
|
| Hospital Charge Code |
5307032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.83 |
| Max. Negotiated Rate |
$1,639.00 |
| Rate for Payer: Aetna Commercial |
$1,603.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,532.11
|
| Rate for Payer: Aetna Managed Medicare |
$498.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$855.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$944.21
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna Commercial |
$1,639.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.97
|
| Rate for Payer: Health EOS Commercial |
$1,585.55
|
| Rate for Payer: HFN Commercial |
$1,639.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,336.14
|
| Rate for Payer: Multiplan Commercial |
$1,425.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,639.00
|
| Rate for Payer: Quartz Beloit One Network |
$872.94
|
| Rate for Payer: Quartz Commercial |
$1,157.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.91
|
| Rate for Payer: The Alliance Commercial |
$890.76
|
| Rate for Payer: WEA Trust Commercial |
$979.84
|
| Rate for Payer: WPS Commercial |
$1,319.52
|
|
|
ELECTRODE OLYMPUS HF RESECTION 45DEG NEEDLE TUIP/COLLINS KNIFE A22255C
|
Facility
|
IP
|
$1,713.00
|
|
| Hospital Charge Code |
5307032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.94 |
| Max. Negotiated Rate |
$1,639.00 |
| Rate for Payer: Aetna Commercial |
$1,603.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,532.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$944.21
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna Commercial |
$1,639.00
|
| Rate for Payer: Health EOS Commercial |
$1,585.55
|
| Rate for Payer: HFN Commercial |
$1,639.00
|
| Rate for Payer: Multiplan Commercial |
$1,425.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,639.00
|
| Rate for Payer: Quartz Beloit One Network |
$872.94
|
| Rate for Payer: Quartz Commercial |
$1,068.91
|
| Rate for Payer: WEA Trust Commercial |
$979.84
|
| Rate for Payer: WPS Commercial |
$1,319.52
|
|
|
ELECTRODE OLYMPUS OESPRO CUTTING LOOP 24FR M0068802611
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
4520043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$1,004.64 |
| Rate for Payer: Aetna Commercial |
$982.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.12
|
| Rate for Payer: Aetna Managed Medicare |
$305.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$709.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$578.76
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$1,004.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.10
|
| Rate for Payer: Health EOS Commercial |
$971.88
|
| Rate for Payer: HFN Commercial |
$1,004.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$873.60
|
| Rate for Payer: NAPHCARE Commercial |
$655.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.64
|
| Rate for Payer: Quartz Beloit One Network |
$535.08
|
| Rate for Payer: Quartz Commercial |
$709.80
|
| Rate for Payer: Quartz Medicare Advantage |
$655.20
|
| Rate for Payer: The Alliance Commercial |
$546.00
|
| Rate for Payer: WEA Trust Commercial |
$600.60
|
| Rate for Payer: WPS Commercial |
$808.82
|
|
|
ELECTRODE OLYMPUS OESPRO CUTTING LOOP 24FR M0068802611
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
4520043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.08 |
| Max. Negotiated Rate |
$1,004.64 |
| Rate for Payer: Aetna Commercial |
$982.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$578.76
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$1,004.64
|
| Rate for Payer: Health EOS Commercial |
$971.88
|
| Rate for Payer: HFN Commercial |
$1,004.64
|
| Rate for Payer: Multiplan Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.64
|
| Rate for Payer: Quartz Beloit One Network |
$535.08
|
| Rate for Payer: Quartz Commercial |
$655.20
|
| Rate for Payer: WEA Trust Commercial |
$600.60
|
| Rate for Payer: WPS Commercial |
$808.82
|
|
|
ELECTRODE OLYMPUS OES TUIP KNIFE M0068802371
|
Facility
|
OP
|
$1,134.00
|
|
| Hospital Charge Code |
4594918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.22 |
| Max. Negotiated Rate |
$1,085.01 |
| Rate for Payer: Aetna Commercial |
$1,061.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,014.25
|
| Rate for Payer: Aetna Managed Medicare |
$330.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$766.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.06
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$1,085.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.99
|
| Rate for Payer: Health EOS Commercial |
$1,049.63
|
| Rate for Payer: HFN Commercial |
$1,085.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$884.52
|
| Rate for Payer: Multiplan Commercial |
$943.49
|
| Rate for Payer: NAPHCARE Commercial |
$707.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.01
|
| Rate for Payer: Quartz Beloit One Network |
$577.89
|
| Rate for Payer: Quartz Commercial |
$766.58
|
| Rate for Payer: Quartz Medicare Advantage |
$707.62
|
| Rate for Payer: The Alliance Commercial |
$589.68
|
| Rate for Payer: WEA Trust Commercial |
$648.65
|
| Rate for Payer: WPS Commercial |
$873.52
|
|
|
ELECTRODE OLYMPUS OES TUIP KNIFE M0068802371
|
Facility
|
IP
|
$1,134.00
|
|
| Hospital Charge Code |
4594918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.89 |
| Max. Negotiated Rate |
$1,085.01 |
| Rate for Payer: Aetna Commercial |
$1,061.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,014.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.06
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$1,085.01
|
| Rate for Payer: Health EOS Commercial |
$1,049.63
|
| Rate for Payer: HFN Commercial |
$1,085.01
|
| Rate for Payer: Multiplan Commercial |
$943.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.01
|
| Rate for Payer: Quartz Beloit One Network |
$577.89
|
| Rate for Payer: Quartz Commercial |
$707.62
|
| Rate for Payer: WEA Trust Commercial |
$648.65
|
| Rate for Payer: WPS Commercial |
$873.52
|
|
|
ELECTRODE PACING 5FR BIPOLAR 006173P
|
Facility
|
IP
|
$2,930.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
2969649
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,493.13 |
| Max. Negotiated Rate |
$2,803.42 |
| Rate for Payer: Aetna Commercial |
$2,742.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,620.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.02
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$2,803.42
|
| Rate for Payer: Health EOS Commercial |
$2,712.01
|
| Rate for Payer: HFN Commercial |
$2,803.42
|
| Rate for Payer: Multiplan Commercial |
$2,437.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,803.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.13
|
| Rate for Payer: Quartz Commercial |
$1,828.32
|
| Rate for Payer: WEA Trust Commercial |
$1,675.96
|
| Rate for Payer: WPS Commercial |
$2,256.98
|
|
|
ELECTRODE PACING 5FR BIPOLAR 006173P
|
Facility
|
OP
|
$2,930.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
2969649
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$853.22 |
| Max. Negotiated Rate |
$2,803.42 |
| Rate for Payer: Aetna Commercial |
$2,742.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,620.59
|
| Rate for Payer: Aetna Managed Medicare |
$853.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,980.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.02
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$2,803.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,705.26
|
| Rate for Payer: Health EOS Commercial |
$2,712.01
|
| Rate for Payer: HFN Commercial |
$2,803.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,285.40
|
| Rate for Payer: Multiplan Commercial |
$2,437.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,803.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.13
|
| Rate for Payer: Quartz Commercial |
$1,980.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,828.32
|
| Rate for Payer: The Alliance Commercial |
$1,523.60
|
| Rate for Payer: WEA Trust Commercial |
$1,675.96
|
| Rate for Payer: WPS Commercial |
$2,256.98
|
|
|
ELECTRODE PAD PEDIATRIC E751025
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
2963161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
ELECTRODE PAD PEDIATRIC E751025
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
2963161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
ELECTRODE PAIRED SUBDERMAL 8227410
|
Facility
|
IP
|
$1,439.00
|
|
| Hospital Charge Code |
2965310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.31 |
| Max. Negotiated Rate |
$1,376.84 |
| Rate for Payer: Aetna Commercial |
$1,346.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.18
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,376.84
|
| Rate for Payer: Health EOS Commercial |
$1,331.94
|
| Rate for Payer: HFN Commercial |
$1,376.84
|
| Rate for Payer: Multiplan Commercial |
$1,197.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,376.84
|
| Rate for Payer: Quartz Beloit One Network |
$733.31
|
| Rate for Payer: Quartz Commercial |
$897.94
|
| Rate for Payer: WEA Trust Commercial |
$823.11
|
| Rate for Payer: WPS Commercial |
$1,108.46
|
|
|
ELECTRODE PAIRED SUBDERMAL 8227410
|
Facility
|
OP
|
$1,439.00
|
|
| Hospital Charge Code |
2965310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.04 |
| Max. Negotiated Rate |
$1,376.84 |
| Rate for Payer: Aetna Commercial |
$1,346.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.04
|
| Rate for Payer: Aetna Managed Medicare |
$419.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$972.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$748.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$718.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.18
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,376.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$837.50
|
| Rate for Payer: Health EOS Commercial |
$1,331.94
|
| Rate for Payer: HFN Commercial |
$1,376.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,122.42
|
| Rate for Payer: Multiplan Commercial |
$1,197.25
|
| Rate for Payer: NAPHCARE Commercial |
$897.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,376.84
|
| Rate for Payer: Quartz Beloit One Network |
$733.31
|
| Rate for Payer: Quartz Commercial |
$972.76
|
| Rate for Payer: Quartz Medicare Advantage |
$897.94
|
| Rate for Payer: The Alliance Commercial |
$748.28
|
| Rate for Payer: WEA Trust Commercial |
$823.11
|
| Rate for Payer: WPS Commercial |
$1,108.46
|
|
|
ELECTRODE PEDIATRIC LP20E ONLY 11996-000093
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
2963714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$376.27
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
ELECTRODE PEDIATRIC LP20E ONLY 11996-000093
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
2963714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$175.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.34
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$376.27
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$407.63
|
| Rate for Payer: Quartz Medicare Advantage |
$376.27
|
| Rate for Payer: The Alliance Commercial |
$313.56
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
ELECTRODE PEDS 3'S LATEX FREE 2268
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
ELECTRODE PEDS 3'S LATEX FREE 2268
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
ELECTRODE RADIOLUCENT #2570-5
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
2970181
|
|
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 RADIOLUCENT #2570-5
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
2970181
|
|
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 ROLLER 24-28FR A22251C
|
Facility
|
OP
|
$1,844.00
|
|
| Hospital Charge Code |
2965422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.97 |
| Max. Negotiated Rate |
$1,764.34 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Aetna Managed Medicare |
$536.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.41
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,764.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.21
|
| Rate for Payer: Health EOS Commercial |
$1,706.81
|
| Rate for Payer: HFN Commercial |
$1,764.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,438.32
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.34
|
| Rate for Payer: Quartz Beloit One Network |
$939.70
|
| Rate for Payer: Quartz Commercial |
$1,246.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.66
|
| Rate for Payer: The Alliance Commercial |
$958.88
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: WPS Commercial |
$1,420.43
|
|
|
ELECTRODE ROLLER 24-28FR A22251C
|
Facility
|
IP
|
$1,844.00
|
|
| Hospital Charge Code |
2965422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.70 |
| Max. Negotiated Rate |
$1,764.34 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.41
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,764.34
|
| Rate for Payer: Health EOS Commercial |
$1,706.81
|
| Rate for Payer: HFN Commercial |
$1,764.34
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.34
|
| Rate for Payer: Quartz Beloit One Network |
$939.70
|
| Rate for Payer: Quartz Commercial |
$1,150.66
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: WPS Commercial |
$1,420.43
|
|
|
ELECTRODE RT ANGLE PROBE PLUS ETHEPS03
|
Facility
|
IP
|
$1,453.00
|
|
| Hospital Charge Code |
2962908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.45 |
| Max. Negotiated Rate |
$1,390.23 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$906.67
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
ELECTRODE RT ANGLE PROBE PLUS ETHEPS03
|
Facility
|
OP
|
$1,453.00
|
|
| Hospital Charge Code |
2962908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.11 |
| Max. Negotiated Rate |
$1,390.23 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Aetna Managed Medicare |
$423.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$845.65
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,133.34
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: NAPHCARE Commercial |
$906.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$982.23
|
| Rate for Payer: Quartz Medicare Advantage |
$906.67
|
| Rate for Payer: The Alliance Commercial |
$755.56
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
