|
ELECTRODE ROLLER 24-28FR A22251C
|
Facility
|
IP
|
$1,844.00
|
|
| Hospital Charge Code |
2965422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$903.56 |
| Max. Negotiated Rate |
$1,696.48 |
| Rate for Payer: Aetna Commercial |
$1,659.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,585.84
|
| 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: Health EOS Commercial |
$1,641.16
|
| Rate for Payer: HFN Commercial |
$1,696.48
|
| 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 |
$1,106.40
|
| Rate for Payer: WEA Trust Commercial |
$1,014.20
|
| Rate for Payer: WPS Commercial |
$1,365.85
|
|
|
ELECTRODE RT ANGLE PROBE PLUS ETHEPS03
|
Facility
|
IP
|
$1,453.00
|
|
| Hospital Charge Code |
2962908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$711.97 |
| Max. Negotiated Rate |
$1,336.76 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$871.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$871.80
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
ELECTRODE RT ANGLE PROBE PLUS ETHEPS03
|
Facility
|
OP
|
$1,453.00
|
|
| Hospital Charge Code |
2962908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.84 |
| Max. Negotiated Rate |
$5,812.00 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Aetna Managed Medicare |
$406.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.10
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.75
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$871.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$944.45
|
| Rate for Payer: Quartz Medicare Advantage |
$871.80
|
| Rate for Payer: The Alliance Commercial |
$5,812.00
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
ELECTRODES ADULT LP20E/LP1000 DEFIB/AED 11996-000017
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
2963679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.97 |
| Max. Negotiated Rate |
$692.76 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.09
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$692.76
|
| Rate for Payer: Health EOS Commercial |
$670.17
|
| Rate for Payer: HFN Commercial |
$692.76
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: NAPHCARE Commercial |
$451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$692.76
|
| Rate for Payer: Quartz Beloit One Network |
$368.97
|
| Rate for Payer: Quartz Commercial |
$451.80
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
|
ELECTRODES ADULT LP20E/LP1000 DEFIB/AED 11996-000017
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
2963679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.84 |
| Max. Negotiated Rate |
$3,012.00 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.58
|
| Rate for Payer: Aetna Managed Medicare |
$210.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$376.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.09
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$692.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.38
|
| Rate for Payer: Health EOS Commercial |
$670.17
|
| Rate for Payer: HFN Commercial |
$692.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$564.75
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: NAPHCARE Commercial |
$451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$692.76
|
| Rate for Payer: Quartz Beloit One Network |
$368.97
|
| Rate for Payer: Quartz Commercial |
$489.45
|
| Rate for Payer: Quartz Medicare Advantage |
$451.80
|
| Rate for Payer: The Alliance Commercial |
$3,012.00
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
|
ELECTRODES DELUCA
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
2972378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Aetna Managed Medicare |
$68.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.66
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$159.90
|
| Rate for Payer: Quartz Medicare Advantage |
$147.60
|
| Rate for Payer: The Alliance Commercial |
$984.00
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
ELECTRODES DELUCA
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
2972378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$147.60
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
ELECTRODES INFANT #13953A
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2973246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
ELECTRODES INFANT #13953A
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2973246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
ELECTRODE SPIRAL LATEX FREE
|
Facility
|
OP
|
$112.00
|
|
| Hospital Charge Code |
2963008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$31.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$72.80
|
| Rate for Payer: Quartz Medicare Advantage |
$67.20
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
ELECTRODE SPIRAL LATEX FREE
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
2963008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$67.20
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
ELECTRODE TUIP KNIFE A2193 *** OBSOLETE ***
|
Facility
|
IP
|
$1,258.00
|
|
| Hospital Charge Code |
2965424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.42 |
| Max. Negotiated Rate |
$1,157.36 |
| Rate for Payer: Aetna Commercial |
$1,132.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,081.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$666.74
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,157.36
|
| Rate for Payer: Health EOS Commercial |
$1,119.62
|
| Rate for Payer: HFN Commercial |
$1,157.36
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$754.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.36
|
| Rate for Payer: Quartz Beloit One Network |
$616.42
|
| Rate for Payer: Quartz Commercial |
$754.80
|
| Rate for Payer: WEA Trust Commercial |
$691.90
|
| Rate for Payer: WPS Commercial |
$931.80
|
|
|
ELECTRODE TUIP KNIFE A2193 *** OBSOLETE ***
|
Facility
|
OP
|
$1,258.00
|
|
| Hospital Charge Code |
2965424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.24 |
| Max. Negotiated Rate |
$5,032.00 |
| Rate for Payer: Aetna Commercial |
$1,132.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,081.88
|
| Rate for Payer: Aetna Managed Medicare |
$352.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$817.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$629.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$666.74
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,157.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.98
|
| Rate for Payer: Health EOS Commercial |
$1,119.62
|
| Rate for Payer: HFN Commercial |
$1,157.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$943.50
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$754.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.36
|
| Rate for Payer: Quartz Beloit One Network |
$616.42
|
| Rate for Payer: Quartz Commercial |
$817.70
|
| Rate for Payer: Quartz Medicare Advantage |
$754.80
|
| Rate for Payer: The Alliance Commercial |
$5,032.00
|
| Rate for Payer: WEA Trust Commercial |
$691.90
|
| Rate for Payer: WPS Commercial |
$931.80
|
|
|
ELECTRODE VALUTRODE 2 3/4 #9225-53"
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2969781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$15.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
ELECTRODE VALUTRODE 2 3/4 #9225-53"
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2969781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
ELECTRODE VALUTRODE 2 CLOTH #9225-52
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2969773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
ELECTRODE VALUTRODE 2 CLOTH #9225-52
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2969773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
ELECTRODE VAPR PREMIERE 90 227204
|
Facility
|
IP
|
$3,608.00
|
|
| Hospital Charge Code |
2965052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,767.92 |
| Max. Negotiated Rate |
$3,319.36 |
| Rate for Payer: Aetna Commercial |
$3,247.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,102.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,912.24
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$3,319.36
|
| Rate for Payer: Health EOS Commercial |
$3,211.12
|
| Rate for Payer: HFN Commercial |
$3,319.36
|
| Rate for Payer: Multiplan Commercial |
$2,886.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,319.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,767.92
|
| Rate for Payer: Quartz Commercial |
$2,164.80
|
| Rate for Payer: WEA Trust Commercial |
$1,984.40
|
| Rate for Payer: WPS Commercial |
$2,672.45
|
|
|
ELECTRODE VAPR PREMIERE 90 227204
|
Facility
|
OP
|
$3,608.00
|
|
| Hospital Charge Code |
2965052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.24 |
| Max. Negotiated Rate |
$14,432.00 |
| Rate for Payer: Aetna Commercial |
$3,247.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,102.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,010.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,345.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,731.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,912.24
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$3,319.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,019.04
|
| Rate for Payer: Health EOS Commercial |
$3,211.12
|
| Rate for Payer: HFN Commercial |
$3,319.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,706.00
|
| Rate for Payer: Multiplan Commercial |
$2,886.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,319.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,767.92
|
| Rate for Payer: Quartz Commercial |
$2,345.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,164.80
|
| Rate for Payer: The Alliance Commercial |
$14,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,984.40
|
| Rate for Payer: WPS Commercial |
$2,672.45
|
|
|
ELECTROHYDRAULIC LITHOTRIPSY (EHL)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
ELECTROHYDRAULIC LITHOTRIPSY (EHL)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Electrolyte Panel
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$225.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$225.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.20
|
| Rate for Payer: Health EOS Commercial |
$215.67
|
| Rate for Payer: HFN Commercial |
$225.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$225.15
|
| Rate for Payer: Quartz Beloit One Network |
$104.28
|
| Rate for Payer: Quartz Commercial |
$135.09
|
| Rate for Payer: The Alliance Commercial |
$118.50
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
Electrolyte Panel
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$142.20
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
Electrolyte Panel
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Aetna Managed Medicare |
$7.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.64
|
| Rate for Payer: Anthem Medicaid |
$7.24
|
| Rate for Payer: Anthem Medicare Advantage |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.01
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.63
|
| Rate for Payer: Dean Health Medicaid |
$7.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.01
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.01
|
| Rate for Payer: Managed Health Services Medicaid |
$7.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.52
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.24
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$154.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7.01
|
| Rate for Payer: The Alliance Commercial |
$28.04
|
| Rate for Payer: United Healthcare Medicaid |
$7.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.01
|
| Rate for Payer: United Healthcare PPO |
$177.75
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: Wellcare Medicare |
$7.01
|
| Rate for Payer: WMAP Medicaid |
$7.24
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
Electrolytes Fecal
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
977933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
