|
Warmer/Isolette - Daily Charges
|
Facility
IP
|
$268.00
|
|
| Hospital Charge Code |
3003955
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$246.56 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$246.56
|
| Rate for Payer: Health EOS Commercial |
$238.52
|
| Rate for Payer: HFN Commercial |
$246.56
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: NAPHCARE Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$246.56
|
| Rate for Payer: Quartz Beloit One Network |
$131.32
|
| Rate for Payer: Quartz Commercial |
$160.80
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
Warmer/Isolette - Nursery Daily Charges
|
Facility
IP
|
$256.00
|
|
| Hospital Charge Code |
3003947
|
|
Hospital Revenue Code
|
231
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Warmer/Isolette - Nursery Daily Charges
|
Facility
OP
|
$256.00
|
|
| Hospital Charge Code |
3003947
|
|
Hospital Revenue Code
|
231
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$71.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.26
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: The Alliance Commercial |
$1,024.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
WASHER 10.00MM 219.91
|
Facility
IP
|
$189.00
|
|
| Hospital Charge Code |
2967333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| 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 10.00MM 219.91
|
Facility
OP
|
$189.00
|
|
| Hospital Charge Code |
2967333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: The Alliance Commercial |
$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: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
WASHER 13.0MM 219.99
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| 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 13.0MM 219.99
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$167.44 |
| 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: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
WASHER 2MM YELLOW HOFFMANN LIMB 4933-1-711
|
Facility
IP
|
$679.00
|
|
| Hospital Charge Code |
6226127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.71 |
| Max. Negotiated Rate |
$624.68 |
| Rate for Payer: Aetna Commercial |
$611.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.87
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$624.68
|
| Rate for Payer: Health EOS Commercial |
$604.31
|
| Rate for Payer: HFN Commercial |
$624.68
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: NAPHCARE Commercial |
$407.40
|
| Rate for Payer: Preferred Network Access Commercial |
$624.68
|
| Rate for Payer: Quartz Beloit One Network |
$332.71
|
| Rate for Payer: Quartz Commercial |
$407.40
|
| Rate for Payer: WEA Trust Commercial |
$373.45
|
| Rate for Payer: WPS Commercial |
$502.94
|
|
|
WASHER 2MM YELLOW HOFFMANN LIMB 4933-1-711
|
Facility
OP
|
$679.00
|
|
| Hospital Charge Code |
6226127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: Aetna Commercial |
$611.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.94
|
| Rate for Payer: Aetna Managed Medicare |
$190.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$441.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.87
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$624.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.97
|
| Rate for Payer: Health EOS Commercial |
$604.31
|
| Rate for Payer: HFN Commercial |
$624.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$509.25
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: NAPHCARE Commercial |
$407.40
|
| Rate for Payer: Preferred Network Access Commercial |
$624.68
|
| Rate for Payer: Quartz Beloit One Network |
$332.71
|
| Rate for Payer: Quartz Commercial |
$441.35
|
| Rate for Payer: Quartz Medicare Advantage |
$407.40
|
| Rate for Payer: The Alliance Commercial |
$2,716.00
|
| Rate for Payer: WEA Trust Commercial |
$373.45
|
| Rate for Payer: WPS Commercial |
$502.94
|
|
|
WASHER 3.0 CANN SCREW STERILE 04.353.902S
|
Facility
OP
|
$776.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$714.80 |
| Rate for Payer: Aetna Commercial |
$699.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.19
|
| Rate for Payer: Aetna Managed Medicare |
$217.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.79
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$714.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.79
|
| Rate for Payer: Health EOS Commercial |
$691.49
|
| Rate for Payer: HFN Commercial |
$714.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.72
|
| Rate for Payer: Multiplan Commercial |
$621.57
|
| Rate for Payer: NAPHCARE Commercial |
$466.18
|
| Rate for Payer: Preferred Network Access Commercial |
$714.80
|
| Rate for Payer: Quartz Beloit One Network |
$380.71
|
| Rate for Payer: Quartz Commercial |
$505.02
|
| Rate for Payer: Quartz Medicare Advantage |
$466.18
|
| Rate for Payer: WEA Trust Commercial |
$427.33
|
| Rate for Payer: WPS Commercial |
$575.49
|
|
|
WASHER 3.0 CANN SCREW STERILE 04.353.902S
|
Facility
IP
|
$776.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$380.71 |
| Max. Negotiated Rate |
$714.80 |
| Rate for Payer: Aetna Commercial |
$699.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.79
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$714.80
|
| Rate for Payer: Health EOS Commercial |
$691.49
|
| Rate for Payer: HFN Commercial |
$714.80
|
| Rate for Payer: Multiplan Commercial |
$621.57
|
| Rate for Payer: NAPHCARE Commercial |
$466.18
|
| Rate for Payer: Preferred Network Access Commercial |
$714.80
|
| Rate for Payer: Quartz Beloit One Network |
$380.71
|
| Rate for Payer: Quartz Commercial |
$466.18
|
| Rate for Payer: WEA Trust Commercial |
$427.33
|
| Rate for Payer: WPS Commercial |
$575.49
|
|
|
WASHER 3.5/4.0 SCREW 5881003540
|
Facility
OP
|
$514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
WASHER 3.5/4.0 SCREW 5881003540
|
Facility
IP
|
$514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
WASHER 4.0MM ASNIS III SS 390018
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
WASHER 4.0MM ASNIS III SS 390018
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.19
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
WASHER 4MM BLUE HOFFMANN LIMB 4933-1-712
|
Facility
IP
|
$734.00
|
|
| Hospital Charge Code |
5611676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.66 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$440.40
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
WASHER 4MM BLUE HOFFMANN LIMB 4933-1-712
|
Facility
OP
|
$734.00
|
|
| Hospital Charge Code |
5611676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.52 |
| Max. Negotiated Rate |
$2,936.00 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Aetna Managed Medicare |
$205.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.75
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.50
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$477.10
|
| Rate for Payer: Quartz Medicare Advantage |
$440.40
|
| Rate for Payer: The Alliance Commercial |
$2,936.00
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
WASHER 6.5 CANN SCREW STERILE 04.353.907S
|
Facility
OP
|
$776.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$714.80 |
| Rate for Payer: Aetna Commercial |
$699.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.19
|
| Rate for Payer: Aetna Managed Medicare |
$217.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.79
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$714.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.79
|
| Rate for Payer: Health EOS Commercial |
$691.49
|
| Rate for Payer: HFN Commercial |
$714.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.72
|
| Rate for Payer: Multiplan Commercial |
$621.57
|
| Rate for Payer: NAPHCARE Commercial |
$466.18
|
| Rate for Payer: Preferred Network Access Commercial |
$714.80
|
| Rate for Payer: Quartz Beloit One Network |
$380.71
|
| Rate for Payer: Quartz Commercial |
$505.02
|
| Rate for Payer: Quartz Medicare Advantage |
$466.18
|
| Rate for Payer: WEA Trust Commercial |
$427.33
|
| Rate for Payer: WPS Commercial |
$575.49
|
|
|
WASHER 6.5 CANN SCREW STERILE 04.353.907S
|
Facility
IP
|
$776.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$380.71 |
| Max. Negotiated Rate |
$714.80 |
| Rate for Payer: Aetna Commercial |
$699.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.79
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$714.80
|
| Rate for Payer: Health EOS Commercial |
$691.49
|
| Rate for Payer: HFN Commercial |
$714.80
|
| Rate for Payer: Multiplan Commercial |
$621.57
|
| Rate for Payer: NAPHCARE Commercial |
$466.18
|
| Rate for Payer: Preferred Network Access Commercial |
$714.80
|
| Rate for Payer: Quartz Beloit One Network |
$380.71
|
| Rate for Payer: Quartz Commercial |
$466.18
|
| Rate for Payer: WEA Trust Commercial |
$427.33
|
| Rate for Payer: WPS Commercial |
$575.49
|
|
|
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 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: 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 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: 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
OP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$550.16 |
| 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: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
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: 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
|
|
