|
ELECTRODE L-HOOK LAPAROSCOPIC E3774-36C
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
2965848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$3,220.00 |
| Rate for Payer: Aetna Commercial |
$724.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$692.30
|
| Rate for Payer: Aetna Managed Medicare |
$225.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$386.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$426.65
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$740.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.48
|
| Rate for Payer: Health EOS Commercial |
$716.45
|
| Rate for Payer: HFN Commercial |
$740.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.75
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: NAPHCARE Commercial |
$483.00
|
| Rate for Payer: Preferred Network Access Commercial |
$740.60
|
| Rate for Payer: Quartz Beloit One Network |
$394.45
|
| Rate for Payer: Quartz Commercial |
$523.25
|
| Rate for Payer: Quartz Medicare Advantage |
$483.00
|
| Rate for Payer: The Alliance Commercial |
$3,220.00
|
| Rate for Payer: WEA Trust Commercial |
$442.75
|
| Rate for Payer: WPS Commercial |
$596.26
|
|
|
ELECTRODE L-HOOK LAPAROSCOPIC E3774-36C
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
2965848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.45 |
| Max. Negotiated Rate |
$740.60 |
| Rate for Payer: Aetna Commercial |
$724.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$426.65
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$740.60
|
| Rate for Payer: Health EOS Commercial |
$716.45
|
| Rate for Payer: HFN Commercial |
$740.60
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: NAPHCARE Commercial |
$483.00
|
| Rate for Payer: Preferred Network Access Commercial |
$740.60
|
| Rate for Payer: Quartz Beloit One Network |
$394.45
|
| Rate for Payer: Quartz Commercial |
$483.00
|
| Rate for Payer: WEA Trust Commercial |
$442.75
|
| Rate for Payer: WPS Commercial |
$596.26
|
|
|
Electrode Monitoring 5'S
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Electrode Monitoring 5'S
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
ELECTRODE NEEDLE E1552
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2963049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
ELECTRODE NEEDLE E1552
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2963049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$20.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$44.40
|
| Rate for Payer: The Alliance Commercial |
$296.00
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
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 |
$479.64 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Aetna Commercial |
$1,541.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.18
|
| Rate for Payer: Aetna Managed Medicare |
$479.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.89
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna Commercial |
$1,575.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.59
|
| Rate for Payer: Health EOS Commercial |
$1,524.57
|
| Rate for Payer: HFN Commercial |
$1,575.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.75
|
| Rate for Payer: Multiplan Commercial |
$1,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.96
|
| Rate for Payer: Quartz Beloit One Network |
$839.37
|
| Rate for Payer: Quartz Commercial |
$1,113.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.80
|
| Rate for Payer: The Alliance Commercial |
$6,852.00
|
| Rate for Payer: WEA Trust Commercial |
$942.15
|
| Rate for Payer: WPS Commercial |
$1,268.82
|
|
|
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 |
$839.37 |
| Max. Negotiated Rate |
$1,575.96 |
| Rate for Payer: Aetna Commercial |
$1,541.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.89
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna Commercial |
$1,575.96
|
| Rate for Payer: Health EOS Commercial |
$1,524.57
|
| Rate for Payer: HFN Commercial |
$1,575.96
|
| Rate for Payer: Multiplan Commercial |
$1,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.96
|
| Rate for Payer: Quartz Beloit One Network |
$839.37
|
| Rate for Payer: Quartz Commercial |
$1,027.80
|
| Rate for Payer: WEA Trust Commercial |
$942.15
|
| Rate for Payer: WPS Commercial |
$1,268.82
|
|
|
ELECTRODE OLYMPUS OESPRO CUTTING LOOP 24FR M0068802611
|
Facility
|
IP
|
$1,050.00
|
|
| Hospital Charge Code |
4520043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna Commercial |
$945.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$556.50
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$966.00
|
| Rate for Payer: Health EOS Commercial |
$934.50
|
| Rate for Payer: HFN Commercial |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: NAPHCARE Commercial |
$630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$966.00
|
| Rate for Payer: Quartz Beloit One Network |
$514.50
|
| Rate for Payer: Quartz Commercial |
$630.00
|
| Rate for Payer: WEA Trust Commercial |
$577.50
|
| Rate for Payer: WPS Commercial |
$777.74
|
|
|
ELECTRODE OLYMPUS OESPRO CUTTING LOOP 24FR M0068802611
|
Facility
|
OP
|
$1,050.00
|
|
| Hospital Charge Code |
4520043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$945.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.00
|
| Rate for Payer: Aetna Managed Medicare |
$294.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$682.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$556.50
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$966.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$587.58
|
| Rate for Payer: Health EOS Commercial |
$934.50
|
| Rate for Payer: HFN Commercial |
$966.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: NAPHCARE Commercial |
$630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$966.00
|
| Rate for Payer: Quartz Beloit One Network |
$514.50
|
| Rate for Payer: Quartz Commercial |
$682.50
|
| Rate for Payer: Quartz Medicare Advantage |
$630.00
|
| Rate for Payer: The Alliance Commercial |
$4,200.00
|
| Rate for Payer: WEA Trust Commercial |
$577.50
|
| Rate for Payer: WPS Commercial |
$777.74
|
|
|
ELECTRODE OLYMPUS OES TUIP KNIFE M0068802371
|
Facility
|
OP
|
$1,134.00
|
|
| Hospital Charge Code |
4594918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.52 |
| Max. Negotiated Rate |
$4,536.00 |
| Rate for Payer: Aetna Commercial |
$1,020.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$975.24
|
| Rate for Payer: Aetna Managed Medicare |
$317.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.02
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$1,043.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$634.59
|
| Rate for Payer: Health EOS Commercial |
$1,009.26
|
| Rate for Payer: HFN Commercial |
$1,043.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$850.50
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: NAPHCARE Commercial |
$680.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,043.28
|
| Rate for Payer: Quartz Beloit One Network |
$555.66
|
| Rate for Payer: Quartz Commercial |
$737.10
|
| Rate for Payer: Quartz Medicare Advantage |
$680.40
|
| Rate for Payer: The Alliance Commercial |
$4,536.00
|
| Rate for Payer: WEA Trust Commercial |
$623.70
|
| Rate for Payer: WPS Commercial |
$839.95
|
|
|
ELECTRODE OLYMPUS OES TUIP KNIFE M0068802371
|
Facility
|
IP
|
$1,134.00
|
|
| Hospital Charge Code |
4594918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.66 |
| Max. Negotiated Rate |
$1,043.28 |
| Rate for Payer: Aetna Commercial |
$1,020.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$975.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.02
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$1,043.28
|
| Rate for Payer: Health EOS Commercial |
$1,009.26
|
| Rate for Payer: HFN Commercial |
$1,043.28
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: NAPHCARE Commercial |
$680.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,043.28
|
| Rate for Payer: Quartz Beloit One Network |
$555.66
|
| Rate for Payer: Quartz Commercial |
$680.40
|
| Rate for Payer: WEA Trust Commercial |
$623.70
|
| Rate for Payer: WPS Commercial |
$839.95
|
|
|
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 |
$1,435.70 |
| Max. Negotiated Rate |
$2,695.60 |
| Rate for Payer: Aetna Commercial |
$2,637.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.90
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$2,695.60
|
| Rate for Payer: Health EOS Commercial |
$2,607.70
|
| Rate for Payer: HFN Commercial |
$2,695.60
|
| Rate for Payer: Multiplan Commercial |
$2,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,758.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.70
|
| Rate for Payer: Quartz Commercial |
$1,758.00
|
| Rate for Payer: WEA Trust Commercial |
$1,611.50
|
| Rate for Payer: WPS Commercial |
$2,170.25
|
|
|
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 |
$820.40 |
| Max. Negotiated Rate |
$11,720.00 |
| Rate for Payer: Aetna Commercial |
$2,637.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.80
|
| Rate for Payer: Aetna Managed Medicare |
$820.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,904.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,465.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,406.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.90
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$2,695.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.63
|
| Rate for Payer: Health EOS Commercial |
$2,607.70
|
| Rate for Payer: HFN Commercial |
$2,695.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,197.50
|
| Rate for Payer: Multiplan Commercial |
$2,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,758.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.70
|
| Rate for Payer: Quartz Commercial |
$1,904.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,758.00
|
| Rate for Payer: The Alliance Commercial |
$11,720.00
|
| Rate for Payer: WEA Trust Commercial |
$1,611.50
|
| Rate for Payer: WPS Commercial |
$2,170.25
|
|
|
ELECTRODE PAD PEDIATRIC E751025
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
2963161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
ELECTRODE PAD PEDIATRIC E751025
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
2963161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$29.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$64.20
|
| Rate for Payer: The Alliance Commercial |
$428.00
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
ELECTRODE PAIRED SUBDERMAL 8227410
|
Facility
|
OP
|
$1,439.00
|
|
| Hospital Charge Code |
2965310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.92 |
| Max. Negotiated Rate |
$5,756.00 |
| Rate for Payer: Aetna Commercial |
$1,295.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,237.54
|
| Rate for Payer: Aetna Managed Medicare |
$402.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$935.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$719.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.67
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,323.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$805.26
|
| Rate for Payer: Health EOS Commercial |
$1,280.71
|
| Rate for Payer: HFN Commercial |
$1,323.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,079.25
|
| Rate for Payer: Multiplan Commercial |
$1,151.20
|
| Rate for Payer: NAPHCARE Commercial |
$863.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.88
|
| Rate for Payer: Quartz Beloit One Network |
$705.11
|
| Rate for Payer: Quartz Commercial |
$935.35
|
| Rate for Payer: Quartz Medicare Advantage |
$863.40
|
| Rate for Payer: The Alliance Commercial |
$5,756.00
|
| Rate for Payer: WEA Trust Commercial |
$791.45
|
| Rate for Payer: WPS Commercial |
$1,065.87
|
|
|
ELECTRODE PAIRED SUBDERMAL 8227410
|
Facility
|
IP
|
$1,439.00
|
|
| Hospital Charge Code |
2965310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.11 |
| Max. Negotiated Rate |
$1,323.88 |
| Rate for Payer: Aetna Commercial |
$1,295.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,237.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.67
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,323.88
|
| Rate for Payer: Health EOS Commercial |
$1,280.71
|
| Rate for Payer: HFN Commercial |
$1,323.88
|
| Rate for Payer: Multiplan Commercial |
$1,151.20
|
| Rate for Payer: NAPHCARE Commercial |
$863.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.88
|
| Rate for Payer: Quartz Beloit One Network |
$705.11
|
| Rate for Payer: Quartz Commercial |
$863.40
|
| Rate for Payer: WEA Trust Commercial |
$791.45
|
| Rate for Payer: WPS Commercial |
$1,065.87
|
|
|
ELECTRODE PEDIATRIC LP20E ONLY 11996-000093
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
2963714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$554.76 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$361.80
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
ELECTRODE PEDIATRIC LP20E ONLY 11996-000093
|
Facility
|
OP
|
$603.00
|
|
| Hospital Charge Code |
2963714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.84 |
| Max. Negotiated Rate |
$2,412.00 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Aetna Managed Medicare |
$168.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.44
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.25
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$391.95
|
| Rate for Payer: Quartz Medicare Advantage |
$361.80
|
| Rate for Payer: The Alliance Commercial |
$2,412.00
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
ELECTRODE PEDS 3'S LATEX FREE 2268
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
ELECTRODE PEDS 3'S LATEX FREE 2268
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
ELECTRODE RADIOLUCENT #2570-5
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
2970181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ELECTRODE RADIOLUCENT #2570-5
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
2970181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ELECTRODE ROLLER 24-28FR A22251C
|
Facility
|
OP
|
$1,844.00
|
|
| Hospital Charge Code |
2965422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.32 |
| Max. Negotiated Rate |
$7,376.00 |
| Rate for Payer: Aetna Commercial |
$1,659.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,585.84
|
| Rate for Payer: Aetna Managed Medicare |
$516.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,198.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$922.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$885.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.32
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,696.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,031.90
|
| Rate for Payer: Health EOS Commercial |
$1,641.16
|
| Rate for Payer: HFN Commercial |
$1,696.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,383.00
|
| Rate for Payer: Multiplan Commercial |
$1,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,696.48
|
| Rate for Payer: Quartz Beloit One Network |
$903.56
|
| Rate for Payer: Quartz Commercial |
$1,198.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,106.40
|
| Rate for Payer: The Alliance Commercial |
$7,376.00
|
| Rate for Payer: WEA Trust Commercial |
$1,014.20
|
| Rate for Payer: WPS Commercial |
$1,365.85
|
|
