|
WASHER 6.5MM 219.972
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
2967335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
WASHER 6.5MM 219.972
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2967335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
WASHER 7.0MM 219.98 (SM & MINI)
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
WASHER 7.0MM 219.98 (SM & MINI)
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
WASHER 7.0MM AR-8870W
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
WASHER 7.0MM AR-8870W
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.64
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$2,392.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
IP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.94 |
| Max. Negotiated Rate |
$649.52 |
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.18
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$649.52
|
| Rate for Payer: Health EOS Commercial |
$628.34
|
| Rate for Payer: HFN Commercial |
$649.52
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: NAPHCARE Commercial |
$423.60
|
| Rate for Payer: Preferred Network Access Commercial |
$649.52
|
| Rate for Payer: Quartz Beloit One Network |
$345.94
|
| Rate for Payer: Quartz Commercial |
$423.60
|
| Rate for Payer: WEA Trust Commercial |
$388.30
|
| Rate for Payer: WPS Commercial |
$522.93
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
OP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.68 |
| Max. Negotiated Rate |
$2,824.00 |
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.16
|
| Rate for Payer: Aetna Managed Medicare |
$197.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.18
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$649.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.08
|
| Rate for Payer: Health EOS Commercial |
$628.34
|
| Rate for Payer: HFN Commercial |
$649.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.50
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: NAPHCARE Commercial |
$423.60
|
| Rate for Payer: Preferred Network Access Commercial |
$649.52
|
| Rate for Payer: Quartz Beloit One Network |
$345.94
|
| Rate for Payer: Quartz Commercial |
$458.90
|
| Rate for Payer: Quartz Medicare Advantage |
$423.60
|
| Rate for Payer: The Alliance Commercial |
$2,824.00
|
| Rate for Payer: WEA Trust Commercial |
$388.30
|
| Rate for Payer: WPS Commercial |
$522.93
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.16 |
| Max. Negotiated Rate |
$2,588.00 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$181.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$362.06
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.25
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$420.55
|
| Rate for Payer: Quartz Medicare Advantage |
$388.20
|
| Rate for Payer: The Alliance Commercial |
$2,588.00
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$388.20
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
IP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
OP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.88 |
| Max. Negotiated Rate |
$6,284.00 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$439.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.13
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,178.25
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| Rate for Payer: Quartz Medicare Advantage |
$942.60
|
| Rate for Payer: The Alliance Commercial |
$6,284.00
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
IP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.11 |
| Max. Negotiated Rate |
$2,243.88 |
| Rate for Payer: Aetna Commercial |
$2,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.67
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,243.88
|
| Rate for Payer: Health EOS Commercial |
$2,170.71
|
| Rate for Payer: HFN Commercial |
$2,243.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.11
|
| Rate for Payer: Quartz Commercial |
$1,463.40
|
| Rate for Payer: WEA Trust Commercial |
$1,341.45
|
| Rate for Payer: WPS Commercial |
$1,806.57
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
OP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.92 |
| Max. Negotiated Rate |
$9,756.00 |
| Rate for Payer: Aetna Commercial |
$2,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.54
|
| Rate for Payer: Aetna Managed Medicare |
$682.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,170.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.67
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,243.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,364.86
|
| Rate for Payer: Health EOS Commercial |
$2,170.71
|
| Rate for Payer: HFN Commercial |
$2,243.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.25
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.11
|
| Rate for Payer: Quartz Commercial |
$1,585.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.40
|
| Rate for Payer: The Alliance Commercial |
$9,756.00
|
| Rate for Payer: WEA Trust Commercial |
$1,341.45
|
| Rate for Payer: WPS Commercial |
$1,806.57
|
|
|
WASHER STRYKER 619905
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.97 |
| Max. Negotiated Rate |
$416.76 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$271.80
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WASHER STRYKER 619905
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Aetna Managed Medicare |
$126.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.50
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$294.45
|
| Rate for Payer: Quartz Medicare Advantage |
$271.80
|
| Rate for Payer: The Alliance Commercial |
$1,812.00
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
WASHER THREADED 219.89
|
Facility
|
IP
|
$791.00
|
|
| Hospital Charge Code |
2967338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.59 |
| Max. Negotiated Rate |
$727.72 |
| Rate for Payer: Aetna Commercial |
$711.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$680.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.23
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$727.72
|
| Rate for Payer: Health EOS Commercial |
$703.99
|
| Rate for Payer: HFN Commercial |
$727.72
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: NAPHCARE Commercial |
$474.60
|
| Rate for Payer: Preferred Network Access Commercial |
$727.72
|
| Rate for Payer: Quartz Beloit One Network |
$387.59
|
| Rate for Payer: Quartz Commercial |
$474.60
|
| Rate for Payer: WEA Trust Commercial |
$435.05
|
| Rate for Payer: WPS Commercial |
$585.89
|
|
|
WASHER THREADED 219.89
|
Facility
|
OP
|
$791.00
|
|
| Hospital Charge Code |
2967338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$3,164.00 |
| Rate for Payer: Aetna Commercial |
$711.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$680.26
|
| Rate for Payer: Aetna Managed Medicare |
$221.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.23
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$727.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.64
|
| Rate for Payer: Health EOS Commercial |
$703.99
|
| Rate for Payer: HFN Commercial |
$727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$593.25
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: NAPHCARE Commercial |
$474.60
|
| Rate for Payer: Preferred Network Access Commercial |
$727.72
|
| Rate for Payer: Quartz Beloit One Network |
$387.59
|
| Rate for Payer: Quartz Commercial |
$514.15
|
| Rate for Payer: Quartz Medicare Advantage |
$474.60
|
| Rate for Payer: The Alliance Commercial |
$3,164.00
|
| Rate for Payer: WEA Trust Commercial |
$435.05
|
| Rate for Payer: WPS Commercial |
$585.89
|
|
|
WASTE BAG 10 L CELL SAVER CSE-B-1000
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
5810149
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$35.40
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
WASTE BAG 10 L CELL SAVER CSE-B-1000
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
5810149
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
WEARABLE DEFIBRILLATOR SYSTEM 93292
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 93292
|
| Hospital Charge Code |
3015364
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.00
|
| Rate for Payer: Health EOS Commercial |
$291.20
|
| Rate for Payer: HFN Commercial |
$304.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$167.78
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Preferred Network Access Commercial |
$304.00
|
| Rate for Payer: Quartz Beloit One Network |
$140.80
|
| Rate for Payer: Quartz Commercial |
$182.40
|
| Rate for Payer: The Alliance Commercial |
$160.00
|
| Rate for Payer: United Healthcare Medicaid |
$34.85
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Wearable ECG Monitor/Report,24Hrs,W/ Superimp Scan Interp;Phys
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
1188827
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$727.56
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$803.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$507.60
|
| Rate for Payer: Health EOS Commercial |
$769.86
|
| Rate for Payer: HFN Commercial |
$803.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Preferred Network Access Commercial |
$803.70
|
| Rate for Payer: Quartz Beloit One Network |
$372.24
|
| Rate for Payer: Quartz Commercial |
$482.22
|
| Rate for Payer: The Alliance Commercial |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$465.30
|
| Rate for Payer: WPS Commercial |
$626.63
|
|
|
WEAVER DUNN PROCEDURE
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
