|
ROD HOFFMANN 3 VECTRAN 11MM X 400MM 4922-8-400
|
Facility
|
OP
|
$3,254.00
|
|
| Hospital Charge Code |
5685715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.56 |
| Max. Negotiated Rate |
$3,113.43 |
| Rate for Payer: Aetna Commercial |
$3,045.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,910.38
|
| Rate for Payer: Aetna Managed Medicare |
$947.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,199.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,692.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,624.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,793.60
|
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cigna Commercial |
$3,113.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,893.83
|
| Rate for Payer: Health EOS Commercial |
$3,011.90
|
| Rate for Payer: HFN Commercial |
$3,113.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,538.12
|
| Rate for Payer: Multiplan Commercial |
$2,707.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,030.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,113.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,658.24
|
| Rate for Payer: Quartz Commercial |
$2,199.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,030.50
|
| Rate for Payer: The Alliance Commercial |
$1,692.08
|
| Rate for Payer: WEA Trust Commercial |
$1,861.29
|
| Rate for Payer: WPS Commercial |
$2,506.56
|
|
|
ROD LOOP OSTOMY 2 INCH 72616
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
5384903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
ROD LOOP OSTOMY 2 INCH 72616
|
Facility
|
IP
|
$447.00
|
|
| Hospital Charge Code |
5384903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
ROD LOOP OSTOMY 3 INCH 72617
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
5384905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
ROD LOOP OSTOMY 3 INCH 72617
|
Facility
|
IP
|
$447.00
|
|
| Hospital Charge Code |
5384905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
ROD REAMING 2.5MM BALL TIP 351.706S
|
Facility
|
OP
|
$1,004.00
|
|
| Hospital Charge Code |
2966794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.36 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Aetna Commercial |
$939.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.98
|
| Rate for Payer: Aetna Managed Medicare |
$292.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.40
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$960.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.33
|
| Rate for Payer: Health EOS Commercial |
$929.30
|
| Rate for Payer: HFN Commercial |
$960.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.12
|
| Rate for Payer: Multiplan Commercial |
$835.33
|
| Rate for Payer: NAPHCARE Commercial |
$626.50
|
| Rate for Payer: Preferred Network Access Commercial |
$960.63
|
| Rate for Payer: Quartz Beloit One Network |
$511.64
|
| Rate for Payer: Quartz Commercial |
$678.70
|
| Rate for Payer: Quartz Medicare Advantage |
$626.50
|
| Rate for Payer: The Alliance Commercial |
$522.08
|
| Rate for Payer: WEA Trust Commercial |
$574.29
|
| Rate for Payer: WPS Commercial |
$773.38
|
|
|
ROD REAMING 2.5MM BALL TIP 351.706S
|
Facility
|
IP
|
$1,004.00
|
|
| Hospital Charge Code |
2966794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$960.63 |
| Rate for Payer: Aetna Commercial |
$939.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.40
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$960.63
|
| Rate for Payer: Health EOS Commercial |
$929.30
|
| Rate for Payer: HFN Commercial |
$960.63
|
| Rate for Payer: Multiplan Commercial |
$835.33
|
| Rate for Payer: Preferred Network Access Commercial |
$960.63
|
| Rate for Payer: Quartz Beloit One Network |
$511.64
|
| Rate for Payer: Quartz Commercial |
$626.50
|
| Rate for Payer: WEA Trust Commercial |
$574.29
|
| Rate for Payer: WPS Commercial |
$773.38
|
|
|
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 |
$646.17 |
| Max. Negotiated Rate |
$2,123.14 |
| Rate for Payer: Aetna Commercial |
$2,076.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.67
|
| Rate for Payer: Aetna Managed Medicare |
$646.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,500.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,153.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,107.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.11
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,123.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,291.46
|
| Rate for Payer: Health EOS Commercial |
$2,053.91
|
| Rate for Payer: HFN Commercial |
$2,123.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,730.82
|
| Rate for Payer: Multiplan Commercial |
$1,846.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.80
|
| Rate for Payer: Quartz Commercial |
$1,500.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,384.66
|
| Rate for Payer: The Alliance Commercial |
$1,153.88
|
| Rate for Payer: WEA Trust Commercial |
$1,269.27
|
| Rate for Payer: WPS Commercial |
$1,709.30
|
|
|
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 |
$1,130.80 |
| Max. Negotiated Rate |
$2,123.14 |
| Rate for Payer: Aetna Commercial |
$2,076.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.11
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,123.14
|
| Rate for Payer: Health EOS Commercial |
$2,053.91
|
| Rate for Payer: HFN Commercial |
$2,123.14
|
| Rate for Payer: Multiplan Commercial |
$1,846.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.80
|
| Rate for Payer: Quartz Commercial |
$1,384.66
|
| Rate for Payer: WEA Trust Commercial |
$1,269.27
|
| Rate for Payer: WPS Commercial |
$1,709.30
|
|
|
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 |
$1,688.67 |
| Max. Negotiated Rate |
$5,548.48 |
| Rate for Payer: Aetna Commercial |
$5,427.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,688.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,920.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,015.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,894.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.41
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,548.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,375.02
|
| Rate for Payer: Health EOS Commercial |
$5,367.55
|
| Rate for Payer: HFN Commercial |
$5,548.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,523.22
|
| Rate for Payer: Multiplan Commercial |
$4,824.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,618.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.17
|
| Rate for Payer: Quartz Commercial |
$3,920.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,618.58
|
| Rate for Payer: The Alliance Commercial |
$3,015.48
|
| Rate for Payer: WEA Trust Commercial |
$3,317.03
|
| Rate for Payer: WPS Commercial |
$4,466.97
|
|
|
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 |
$2,955.17 |
| Max. Negotiated Rate |
$5,548.48 |
| Rate for Payer: Aetna Commercial |
$5,427.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.41
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,548.48
|
| Rate for Payer: Health EOS Commercial |
$5,367.55
|
| Rate for Payer: HFN Commercial |
$5,548.48
|
| Rate for Payer: Multiplan Commercial |
$4,824.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.17
|
| Rate for Payer: Quartz Commercial |
$3,618.58
|
| Rate for Payer: WEA Trust Commercial |
$3,317.03
|
| Rate for Payer: WPS Commercial |
$4,466.97
|
|
|
ROLL ON IT STAYS BODY ADHESIVE #9297-94
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2970812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
ROLL ON IT STAYS BODY ADHESIVE #9297-94
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2970812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
ROOM/BED: Convenience
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
2944489
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$797.01 |
| Max. Negotiated Rate |
$1,496.44 |
| Rate for Payer: Aetna Commercial |
$1,463.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,398.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$862.08
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,496.44
|
| Rate for Payer: Health EOS Commercial |
$1,447.64
|
| Rate for Payer: HFN Commercial |
$1,496.44
|
| Rate for Payer: Multiplan Commercial |
$1,301.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,496.44
|
| Rate for Payer: Quartz Beloit One Network |
$797.01
|
| Rate for Payer: Quartz Commercial |
$975.94
|
| Rate for Payer: WEA Trust Commercial |
$894.61
|
| Rate for Payer: WPS Commercial |
$1,204.75
|
|
|
ROOM/BED: Critical Care
|
Facility
|
IP
|
$6,535.00
|
|
| Hospital Charge Code |
2944499
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$3,330.24 |
| Max. Negotiated Rate |
$6,252.69 |
| Rate for Payer: Aetna Commercial |
$6,116.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,844.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,602.09
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$6,252.69
|
| Rate for Payer: Health EOS Commercial |
$6,048.80
|
| Rate for Payer: HFN Commercial |
$6,252.69
|
| Rate for Payer: Multiplan Commercial |
$5,437.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,252.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,330.24
|
| Rate for Payer: Quartz Commercial |
$4,077.84
|
| Rate for Payer: WEA Trust Commercial |
$3,738.02
|
| Rate for Payer: WPS Commercial |
$5,033.91
|
|
|
ROOM/BED: Hospice
|
Facility
|
IP
|
$1,452.00
|
|
| Hospital Charge Code |
2944491
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$739.94 |
| Max. Negotiated Rate |
$1,389.27 |
| Rate for Payer: Aetna Commercial |
$1,359.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,298.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.34
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$1,389.27
|
| Rate for Payer: Health EOS Commercial |
$1,343.97
|
| Rate for Payer: HFN Commercial |
$1,389.27
|
| Rate for Payer: Multiplan Commercial |
$1,208.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,389.27
|
| Rate for Payer: Quartz Beloit One Network |
$739.94
|
| Rate for Payer: Quartz Commercial |
$906.05
|
| Rate for Payer: WEA Trust Commercial |
$830.54
|
| Rate for Payer: WPS Commercial |
$1,118.48
|
|
|
ROOM/BED: Intermediate
|
Facility
|
IP
|
$2,771.00
|
|
| Hospital Charge Code |
2944488
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,412.10 |
| Max. Negotiated Rate |
$2,651.29 |
| Rate for Payer: Aetna Commercial |
$2,593.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,478.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,527.38
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,651.29
|
| Rate for Payer: Health EOS Commercial |
$2,564.84
|
| Rate for Payer: HFN Commercial |
$2,651.29
|
| Rate for Payer: Multiplan Commercial |
$2,305.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,651.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,412.10
|
| Rate for Payer: Quartz Commercial |
$1,729.10
|
| Rate for Payer: WEA Trust Commercial |
$1,585.01
|
| Rate for Payer: WPS Commercial |
$2,134.50
|
|
|
ROOM/BED: Joint Replacement
|
Facility
|
IP
|
$1,727.00
|
|
| Hospital Charge Code |
2944494
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$880.08 |
| Max. Negotiated Rate |
$1,652.39 |
| Rate for Payer: Aetna Commercial |
$1,616.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,544.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.92
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cigna Commercial |
$1,652.39
|
| Rate for Payer: Health EOS Commercial |
$1,598.51
|
| Rate for Payer: HFN Commercial |
$1,652.39
|
| Rate for Payer: Multiplan Commercial |
$1,436.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.39
|
| Rate for Payer: Quartz Beloit One Network |
$880.08
|
| Rate for Payer: Quartz Commercial |
$1,077.65
|
| Rate for Payer: WEA Trust Commercial |
$987.84
|
| Rate for Payer: WPS Commercial |
$1,330.31
|
|
|
ROOM/BED: Med Surg
|
Facility
|
IP
|
$1,580.00
|
|
| Hospital Charge Code |
2944497
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$805.17 |
| Max. Negotiated Rate |
$1,511.74 |
| Rate for Payer: Aetna Commercial |
$1,478.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.90
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$1,511.74
|
| Rate for Payer: Health EOS Commercial |
$1,462.45
|
| Rate for Payer: HFN Commercial |
$1,511.74
|
| Rate for Payer: Multiplan Commercial |
$1,314.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,511.74
|
| Rate for Payer: Quartz Beloit One Network |
$805.17
|
| Rate for Payer: Quartz Commercial |
$985.92
|
| Rate for Payer: WEA Trust Commercial |
$903.76
|
| Rate for Payer: WPS Commercial |
$1,217.07
|
|
|
ROOM/BED: Nursery
|
Facility
|
IP
|
$2,478.00
|
|
| Hospital Charge Code |
2944484
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,262.79 |
| Max. Negotiated Rate |
$2,370.95 |
| Rate for Payer: Aetna Commercial |
$2,319.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.87
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,370.95
|
| Rate for Payer: Health EOS Commercial |
$2,293.64
|
| Rate for Payer: HFN Commercial |
$2,370.95
|
| Rate for Payer: Multiplan Commercial |
$2,061.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.79
|
| Rate for Payer: Quartz Commercial |
$1,546.27
|
| Rate for Payer: WEA Trust Commercial |
$1,417.42
|
| Rate for Payer: WPS Commercial |
$1,908.80
|
|
|
ROOM/BED: Observation
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2944485
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$7,271.68 |
| 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 |
$7,271.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,271.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,958.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| 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: United Healthcare PPO |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
ROOM/BED: Observation
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2944485
|
|
Hospital Revenue Code
|
762
|
| 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
|
|
|
ROOM/BED: Pediatrics
|
Facility
|
IP
|
$1,583.00
|
|
| Hospital Charge Code |
2944496
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$806.70 |
| Max. Negotiated Rate |
$1,514.61 |
| Rate for Payer: Aetna Commercial |
$1,481.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,415.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.55
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,514.61
|
| Rate for Payer: Health EOS Commercial |
$1,465.22
|
| Rate for Payer: HFN Commercial |
$1,514.61
|
| Rate for Payer: Multiplan Commercial |
$1,317.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,514.61
|
| Rate for Payer: Quartz Beloit One Network |
$806.70
|
| Rate for Payer: Quartz Commercial |
$987.79
|
| Rate for Payer: WEA Trust Commercial |
$905.48
|
| Rate for Payer: WPS Commercial |
$1,219.38
|
|
|
ROOM/BED: Pediatrics < 5
|
Facility
|
IP
|
$1,687.00
|
|
| Hospital Charge Code |
2944492
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$859.70 |
| Max. Negotiated Rate |
$1,614.12 |
| Rate for Payer: Aetna Commercial |
$1,579.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.87
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cigna Commercial |
$1,614.12
|
| Rate for Payer: Health EOS Commercial |
$1,561.49
|
| Rate for Payer: HFN Commercial |
$1,614.12
|
| Rate for Payer: Multiplan Commercial |
$1,403.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,614.12
|
| Rate for Payer: Quartz Beloit One Network |
$859.70
|
| Rate for Payer: Quartz Commercial |
$1,052.69
|
| Rate for Payer: WEA Trust Commercial |
$964.96
|
| Rate for Payer: WPS Commercial |
$1,299.50
|
|
|
ROOM/BED: Post Partum
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
2944493
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
