|
ELECTRODES ADULT LP20E/LP1000 DEFIB/AED 11996-000017
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
2963679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.27 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Aetna Managed Medicare |
$219.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.25
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.34
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: NAPHCARE Commercial |
$469.87
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$509.03
|
| Rate for Payer: Quartz Medicare Advantage |
$469.87
|
| Rate for Payer: The Alliance Commercial |
$391.56
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
ELECTRODES ADULT LP20E/LP1000 DEFIB/AED 11996-000017
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
2963679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$383.73 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$469.87
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
ELECTRODES DELUCA
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
2972378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Aetna Managed Medicare |
$71.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.17
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.88
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: NAPHCARE Commercial |
$153.50
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$166.30
|
| Rate for Payer: Quartz Medicare Advantage |
$153.50
|
| Rate for Payer: The Alliance Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
ELECTRODES DELUCA
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
2972378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.36 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
ELECTRODES INFANT #13953A
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2973246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
ELECTRODES INFANT #13953A
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2973246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
ELECTRODE SPIRAL LATEX FREE
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
2963008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
ELECTRODE SPIRAL LATEX FREE
|
Facility
|
OP
|
$112.00
|
|
| Hospital Charge Code |
2963008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$32.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.36
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$69.89
|
| Rate for Payer: The Alliance Commercial |
$58.24
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
ELECTRODE TUIP KNIFE A2193 *** OBSOLETE ***
|
Facility
|
IP
|
$1,258.00
|
|
| Hospital Charge Code |
2965424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.08 |
| Max. Negotiated Rate |
$1,203.65 |
| Rate for Payer: Aetna Commercial |
$1,177.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.41
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,203.65
|
| Rate for Payer: Health EOS Commercial |
$1,164.40
|
| Rate for Payer: HFN Commercial |
$1,203.65
|
| Rate for Payer: Multiplan Commercial |
$1,046.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.65
|
| Rate for Payer: Quartz Beloit One Network |
$641.08
|
| Rate for Payer: Quartz Commercial |
$784.99
|
| Rate for Payer: WEA Trust Commercial |
$719.58
|
| Rate for Payer: WPS Commercial |
$969.04
|
|
|
ELECTRODE TUIP KNIFE A2193 *** OBSOLETE ***
|
Facility
|
OP
|
$1,258.00
|
|
| Hospital Charge Code |
2965424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.33 |
| Max. Negotiated Rate |
$1,203.65 |
| Rate for Payer: Aetna Commercial |
$1,177.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.16
|
| Rate for Payer: Aetna Managed Medicare |
$366.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$627.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.41
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,203.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.16
|
| Rate for Payer: Health EOS Commercial |
$1,164.40
|
| Rate for Payer: HFN Commercial |
$1,203.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.24
|
| Rate for Payer: Multiplan Commercial |
$1,046.66
|
| Rate for Payer: NAPHCARE Commercial |
$784.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.65
|
| Rate for Payer: Quartz Beloit One Network |
$641.08
|
| Rate for Payer: Quartz Commercial |
$850.41
|
| Rate for Payer: Quartz Medicare Advantage |
$784.99
|
| Rate for Payer: The Alliance Commercial |
$654.16
|
| Rate for Payer: WEA Trust Commercial |
$719.58
|
| Rate for Payer: WPS Commercial |
$969.04
|
|
|
ELECTRODE VALUTRODE 2 3/4 #9225-53"
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2969781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
ELECTRODE VALUTRODE 2 3/4 #9225-53"
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2969781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$35.57
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
ELECTRODE VALUTRODE 2 CLOTH #9225-52
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2969773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
ELECTRODE VALUTRODE 2 CLOTH #9225-52
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2969773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
ELECTRODE VAPR PREMIERE 90 227204
|
Facility
|
IP
|
$3,608.00
|
|
| Hospital Charge Code |
2965052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,838.64 |
| Max. Negotiated Rate |
$3,452.13 |
| Rate for Payer: Aetna Commercial |
$3,377.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,227.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.73
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$3,452.13
|
| Rate for Payer: Health EOS Commercial |
$3,339.56
|
| Rate for Payer: HFN Commercial |
$3,452.13
|
| Rate for Payer: Multiplan Commercial |
$3,001.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,452.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,838.64
|
| Rate for Payer: Quartz Commercial |
$2,251.39
|
| Rate for Payer: WEA Trust Commercial |
$2,063.78
|
| Rate for Payer: WPS Commercial |
$2,779.24
|
|
|
ELECTRODE VAPR PREMIERE 90 227204
|
Facility
|
OP
|
$3,608.00
|
|
| Hospital Charge Code |
2965052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,050.65 |
| Max. Negotiated Rate |
$3,452.13 |
| Rate for Payer: Aetna Commercial |
$3,377.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,227.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,050.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,439.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,876.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,801.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.73
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$3,452.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,099.86
|
| Rate for Payer: Health EOS Commercial |
$3,339.56
|
| Rate for Payer: HFN Commercial |
$3,452.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,814.24
|
| Rate for Payer: Multiplan Commercial |
$3,001.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,251.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,452.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,838.64
|
| Rate for Payer: Quartz Commercial |
$2,439.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,251.39
|
| Rate for Payer: The Alliance Commercial |
$1,876.16
|
| Rate for Payer: WEA Trust Commercial |
$2,063.78
|
| Rate for Payer: WPS Commercial |
$2,779.24
|
|
|
ELECTROENCEPHALOGRAM
|
Facility
|
OP
|
$127.10
|
|
|
Service Code
|
EAPG 00211
|
| Min. Negotiated Rate |
$122.21 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Anthem Medicaid |
$122.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$122.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.21
|
| Rate for Payer: Dean Health Medicaid |
$122.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$122.21
|
| Rate for Payer: Managed Health Services Medicaid |
$127.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$122.21
|
| Rate for Payer: United Healthcare Medicaid |
$122.21
|
|
|
ELECTROHYDRAULIC LITHOTRIPSY (EHL)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ELECTROHYDRAULIC LITHOTRIPSY (EHL)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ELECTROLYTE DISORDERS
|
Facility
|
OP
|
$95.65
|
|
|
Service Code
|
EAPG 00694
|
| Min. Negotiated Rate |
$91.97 |
| Max. Negotiated Rate |
$95.65 |
| Rate for Payer: Anthem Medicaid |
$91.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$91.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.97
|
| Rate for Payer: Dean Health Medicaid |
$91.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$91.97
|
| Rate for Payer: Managed Health Services Medicaid |
$95.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$91.97
|
| Rate for Payer: United Healthcare Medicaid |
$91.97
|
|
|
Electrolyte Panel
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Electrolyte Panel
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$7.29
|
| Rate for Payer: Anthem Medicare Advantage |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.29
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.29
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$10.94
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$7.29
|
| Rate for Payer: The Alliance Commercial |
$28.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.29
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$32.08
|
|
|
Electrolyte Panel
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$7.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.10
|
| Rate for Payer: Anthem Medicare Advantage |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.29
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.29
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$10.94
|
| 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 |
$7.29
|
| Rate for Payer: The Alliance Commercial |
$29.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.29
|
| Rate for Payer: United Healthcare PPO |
$184.86
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: Wellcare Medicare |
$7.29
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
Electrolytes Fecal
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
977933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Electrolytes Fecal
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
977933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$5.05
|
| Rate for Payer: Anthem Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.05
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.05
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$7.58
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.05
|
| Rate for Payer: The Alliance Commercial |
$19.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.05
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$22.24
|
|
