|
ROD HOFFMANN 3 VECTRAN 11MM X 400MM 4922-8-400
|
Facility
|
IP
|
$3,254.00
|
|
| Hospital Charge Code |
5685715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,594.46 |
| Max. Negotiated Rate |
$2,993.68 |
| Rate for Payer: Aetna Commercial |
$2,928.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,798.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,724.62
|
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cigna Commercial |
$2,993.68
|
| Rate for Payer: Health EOS Commercial |
$2,896.06
|
| Rate for Payer: HFN Commercial |
$2,993.68
|
| Rate for Payer: Multiplan Commercial |
$2,603.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,952.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,993.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,594.46
|
| Rate for Payer: Quartz Commercial |
$1,952.40
|
| Rate for Payer: WEA Trust Commercial |
$1,789.70
|
| Rate for Payer: WPS Commercial |
$2,410.24
|
|
|
ROD LOOP OSTOMY 2 INCH 72616
|
Facility
|
IP
|
$447.00
|
|
| Hospital Charge Code |
5384903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
ROD LOOP OSTOMY 2 INCH 72616
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
5384903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
ROD LOOP OSTOMY 3 INCH 72617
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
5384905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
ROD LOOP OSTOMY 3 INCH 72617
|
Facility
|
IP
|
$447.00
|
|
| Hospital Charge Code |
5384905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
ROD REAMING 2.5MM BALL TIP 351.706S
|
Facility
|
IP
|
$1,004.00
|
|
| Hospital Charge Code |
2966794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$923.68 |
| Rate for Payer: Aetna Commercial |
$903.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$863.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$532.12
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$923.68
|
| Rate for Payer: Health EOS Commercial |
$893.56
|
| Rate for Payer: HFN Commercial |
$923.68
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: NAPHCARE Commercial |
$602.40
|
| Rate for Payer: Preferred Network Access Commercial |
$923.68
|
| Rate for Payer: Quartz Beloit One Network |
$491.96
|
| Rate for Payer: Quartz Commercial |
$602.40
|
| Rate for Payer: WEA Trust Commercial |
$552.20
|
| Rate for Payer: WPS Commercial |
$743.66
|
|
|
ROD REAMING 2.5MM BALL TIP 351.706S
|
Facility
|
OP
|
$1,004.00
|
|
| Hospital Charge Code |
2966794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.12 |
| Max. Negotiated Rate |
$4,016.00 |
| Rate for Payer: Aetna Commercial |
$903.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$863.44
|
| Rate for Payer: Aetna Managed Medicare |
$281.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$652.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$502.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$532.12
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$923.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.84
|
| Rate for Payer: Health EOS Commercial |
$893.56
|
| Rate for Payer: HFN Commercial |
$923.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: NAPHCARE Commercial |
$602.40
|
| Rate for Payer: Preferred Network Access Commercial |
$923.68
|
| Rate for Payer: Quartz Beloit One Network |
$491.96
|
| Rate for Payer: Quartz Commercial |
$652.60
|
| Rate for Payer: Quartz Medicare Advantage |
$602.40
|
| Rate for Payer: The Alliance Commercial |
$4,016.00
|
| Rate for Payer: WEA Trust Commercial |
$552.20
|
| Rate for Payer: WPS Commercial |
$743.66
|
|
|
ROD REAMING 3.8 BALL TIP 3.0/950 03.233.010S
|
Facility
|
IP
|
$2,219.00
|
|
| Hospital Charge Code |
6180620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.31 |
| Max. Negotiated Rate |
$2,041.48 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,908.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.07
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,041.48
|
| Rate for Payer: Health EOS Commercial |
$1,974.91
|
| Rate for Payer: HFN Commercial |
$2,041.48
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,331.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,041.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,087.31
|
| Rate for Payer: Quartz Commercial |
$1,331.40
|
| Rate for Payer: WEA Trust Commercial |
$1,220.45
|
| Rate for Payer: WPS Commercial |
$1,643.61
|
|
|
ROD REAMING 3.8 BALL TIP 3.0/950 03.233.010S
|
Facility
|
OP
|
$2,219.00
|
|
| Hospital Charge Code |
6180620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$8,876.00 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,908.34
|
| Rate for Payer: Aetna Managed Medicare |
$621.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,442.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,109.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.07
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,041.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,241.75
|
| Rate for Payer: Health EOS Commercial |
$1,974.91
|
| Rate for Payer: HFN Commercial |
$2,041.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,664.25
|
| Rate for Payer: Multiplan Commercial |
$1,775.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,331.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,041.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,087.31
|
| Rate for Payer: Quartz Commercial |
$1,442.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,331.40
|
| Rate for Payer: The Alliance Commercial |
$8,876.00
|
| Rate for Payer: WEA Trust Commercial |
$1,220.45
|
| Rate for Payer: WPS Commercial |
$1,643.61
|
|
|
ROLLER OLYMPUS HF 24-28FR 12/30 DEG WA22751S/WA22351C
|
Facility
|
IP
|
$5,799.00
|
|
| Hospital Charge Code |
4518879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,841.51 |
| Max. Negotiated Rate |
$5,335.08 |
| Rate for Payer: Aetna Commercial |
$5,219.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,987.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,073.47
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,335.08
|
| Rate for Payer: Health EOS Commercial |
$5,161.11
|
| Rate for Payer: HFN Commercial |
$5,335.08
|
| Rate for Payer: Multiplan Commercial |
$4,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,335.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,841.51
|
| Rate for Payer: Quartz Commercial |
$3,479.40
|
| Rate for Payer: WEA Trust Commercial |
$3,189.45
|
| Rate for Payer: WPS Commercial |
$4,295.32
|
|
|
ROLLER OLYMPUS HF 24-28FR 12/30 DEG WA22751S/WA22351C
|
Facility
|
OP
|
$5,799.00
|
|
| Hospital Charge Code |
4518879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,623.72 |
| Max. Negotiated Rate |
$23,196.00 |
| Rate for Payer: Aetna Commercial |
$5,219.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,987.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,623.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,769.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,899.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,783.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,073.47
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,335.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,245.12
|
| Rate for Payer: Health EOS Commercial |
$5,161.11
|
| Rate for Payer: HFN Commercial |
$5,335.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,349.25
|
| Rate for Payer: Multiplan Commercial |
$4,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,335.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,841.51
|
| Rate for Payer: Quartz Commercial |
$3,769.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,479.40
|
| Rate for Payer: The Alliance Commercial |
$23,196.00
|
| Rate for Payer: WEA Trust Commercial |
$3,189.45
|
| Rate for Payer: WPS Commercial |
$4,295.32
|
|
|
ROLL ON IT STAYS BODY ADHESIVE #9297-94
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2970812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
ROLL ON IT STAYS BODY ADHESIVE #9297-94
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2970812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
ROOM/BED: Convenience
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
2944489
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$766.36 |
| Max. Negotiated Rate |
$1,438.88 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.92
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,438.88
|
| Rate for Payer: Health EOS Commercial |
$1,391.96
|
| Rate for Payer: HFN Commercial |
$1,438.88
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$938.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.88
|
| Rate for Payer: Quartz Beloit One Network |
$766.36
|
| Rate for Payer: Quartz Commercial |
$938.40
|
| Rate for Payer: WEA Trust Commercial |
$860.20
|
| Rate for Payer: WPS Commercial |
$1,158.45
|
|
|
ROOM/BED: Critical Care
|
Facility
|
IP
|
$6,535.00
|
|
| Hospital Charge Code |
2944499
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$3,202.15 |
| Max. Negotiated Rate |
$6,012.20 |
| Rate for Payer: Aetna Commercial |
$5,881.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,620.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,463.55
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$6,012.20
|
| Rate for Payer: Health EOS Commercial |
$5,816.15
|
| Rate for Payer: HFN Commercial |
$6,012.20
|
| Rate for Payer: Multiplan Commercial |
$5,228.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,921.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,012.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,202.15
|
| Rate for Payer: Quartz Commercial |
$3,921.00
|
| Rate for Payer: WEA Trust Commercial |
$3,594.25
|
| Rate for Payer: WPS Commercial |
$4,840.47
|
|
|
ROOM/BED: Hospice
|
Facility
|
IP
|
$1,452.00
|
|
| Hospital Charge Code |
2944491
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$711.48 |
| Max. Negotiated Rate |
$1,335.84 |
| Rate for Payer: Aetna Commercial |
$1,306.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,248.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$769.56
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$1,335.84
|
| Rate for Payer: Health EOS Commercial |
$1,292.28
|
| Rate for Payer: HFN Commercial |
$1,335.84
|
| Rate for Payer: Multiplan Commercial |
$1,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$871.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,335.84
|
| Rate for Payer: Quartz Beloit One Network |
$711.48
|
| Rate for Payer: Quartz Commercial |
$871.20
|
| Rate for Payer: WEA Trust Commercial |
$798.60
|
| Rate for Payer: WPS Commercial |
$1,075.50
|
|
|
ROOM/BED: Intermediate
|
Facility
|
IP
|
$2,771.00
|
|
| Hospital Charge Code |
2944488
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,357.79 |
| Max. Negotiated Rate |
$2,549.32 |
| Rate for Payer: Aetna Commercial |
$2,493.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,383.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.63
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,549.32
|
| Rate for Payer: Health EOS Commercial |
$2,466.19
|
| Rate for Payer: HFN Commercial |
$2,549.32
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,549.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.79
|
| Rate for Payer: Quartz Commercial |
$1,662.60
|
| Rate for Payer: WEA Trust Commercial |
$1,524.05
|
| Rate for Payer: WPS Commercial |
$2,052.48
|
|
|
ROOM/BED: Joint Replacement
|
Facility
|
IP
|
$1,727.00
|
|
| Hospital Charge Code |
2944494
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$846.23 |
| Max. Negotiated Rate |
$1,588.84 |
| Rate for Payer: Aetna Commercial |
$1,554.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,485.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$915.31
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cigna Commercial |
$1,588.84
|
| Rate for Payer: Health EOS Commercial |
$1,537.03
|
| Rate for Payer: HFN Commercial |
$1,588.84
|
| Rate for Payer: Multiplan Commercial |
$1,381.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,036.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,588.84
|
| Rate for Payer: Quartz Beloit One Network |
$846.23
|
| Rate for Payer: Quartz Commercial |
$1,036.20
|
| Rate for Payer: WEA Trust Commercial |
$949.85
|
| Rate for Payer: WPS Commercial |
$1,279.19
|
|
|
ROOM/BED: Med Surg
|
Facility
|
IP
|
$1,580.00
|
|
| Hospital Charge Code |
2944497
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$774.20 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna Commercial |
$1,422.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.40
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$1,453.60
|
| Rate for Payer: Health EOS Commercial |
$1,406.20
|
| Rate for Payer: HFN Commercial |
$1,453.60
|
| Rate for Payer: Multiplan Commercial |
$1,264.00
|
| Rate for Payer: NAPHCARE Commercial |
$948.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,453.60
|
| Rate for Payer: Quartz Beloit One Network |
$774.20
|
| Rate for Payer: Quartz Commercial |
$948.00
|
| Rate for Payer: WEA Trust Commercial |
$869.00
|
| Rate for Payer: WPS Commercial |
$1,170.31
|
|
|
ROOM/BED: Nursery
|
Facility
|
IP
|
$2,478.00
|
|
| Hospital Charge Code |
2944484
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,214.22 |
| Max. Negotiated Rate |
$2,279.76 |
| Rate for Payer: Aetna Commercial |
$2,230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.34
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,279.76
|
| Rate for Payer: Health EOS Commercial |
$2,205.42
|
| Rate for Payer: HFN Commercial |
$2,279.76
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.22
|
| Rate for Payer: Quartz Commercial |
$1,486.80
|
| Rate for Payer: WEA Trust Commercial |
$1,362.90
|
| Rate for Payer: WPS Commercial |
$1,835.45
|
|
|
ROOM/BED: Observation
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2944485
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$6,992.00 |
| 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 |
$6,992.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,030.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,729.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| 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: United Healthcare PPO |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
ROOM/BED: Observation
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2944485
|
|
Hospital Revenue Code
|
762
|
| 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
|
|
|
ROOM/BED: Pediatrics
|
Facility
|
IP
|
$1,583.00
|
|
| Hospital Charge Code |
2944496
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$775.67 |
| Max. Negotiated Rate |
$1,456.36 |
| Rate for Payer: Aetna Commercial |
$1,424.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,361.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$838.99
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,456.36
|
| Rate for Payer: Health EOS Commercial |
$1,408.87
|
| Rate for Payer: HFN Commercial |
$1,456.36
|
| Rate for Payer: Multiplan Commercial |
$1,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$949.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,456.36
|
| Rate for Payer: Quartz Beloit One Network |
$775.67
|
| Rate for Payer: Quartz Commercial |
$949.80
|
| Rate for Payer: WEA Trust Commercial |
$870.65
|
| Rate for Payer: WPS Commercial |
$1,172.53
|
|
|
ROOM/BED: Pediatrics < 5
|
Facility
|
IP
|
$1,687.00
|
|
| Hospital Charge Code |
2944492
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$826.63 |
| Max. Negotiated Rate |
$1,552.04 |
| Rate for Payer: Aetna Commercial |
$1,518.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.11
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cigna Commercial |
$1,552.04
|
| Rate for Payer: Health EOS Commercial |
$1,501.43
|
| Rate for Payer: HFN Commercial |
$1,552.04
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.04
|
| Rate for Payer: Quartz Beloit One Network |
$826.63
|
| Rate for Payer: Quartz Commercial |
$1,012.20
|
| Rate for Payer: WEA Trust Commercial |
$927.85
|
| Rate for Payer: WPS Commercial |
$1,249.56
|
|
|
ROOM/BED: Post Partum
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
2944493
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
