|
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 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: 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 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: 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
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 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: 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 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: 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
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$416.76 |
| 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: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
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: 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 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: 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 |
$561.20 |
| 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: 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: 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: 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
|
$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: Aetna Managed Medicare |
$49.34
|
| Rate for Payer: Anthem Medicare Advantage |
$49.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.34
|
| 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 |
$160.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.34
|
| Rate for Payer: Health EOS Commercial |
$291.20
|
| 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: Independent Care Health Plan Medicare |
$49.34
|
| 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: Quartz Medicare Advantage |
$49.34
|
| Rate for Payer: The Alliance Commercial |
$187.49
|
| Rate for Payer: United Healthcare Medicaid |
$34.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.34
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$197.36
|
|
|
Wearable ECG Monitor/Report,24Hrs,W/ Superimp Scan Interp;Phys
|
Professional
|
$846.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
1188827
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$727.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| 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 |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$769.86
|
| 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: Independent Care Health Plan Medicare |
$17.83
|
| 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: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$67.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: WEA Trust Commercial |
$465.30
|
| Rate for Payer: WPS Commercial |
$71.32
|
|
|
WEAVER DUNN PROCEDURE
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| 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: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| 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 |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
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
|
|
|
WEDGE CHRONOS BETA-TCP
|
Facility
OP
|
$8,191.00
|
|
| Hospital Charge Code |
2966591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.48 |
| Max. Negotiated Rate |
$32,764.00 |
| Rate for Payer: Aetna Commercial |
$7,371.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,044.26
|
| Rate for Payer: Aetna Managed Medicare |
$2,293.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,324.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,095.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,931.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,341.23
|
| Rate for Payer: Cash Price |
$2,457.30
|
| Rate for Payer: Cigna Commercial |
$7,535.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,583.68
|
| Rate for Payer: Health EOS Commercial |
$7,289.99
|
| Rate for Payer: HFN Commercial |
$7,535.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,143.25
|
| Rate for Payer: Multiplan Commercial |
$6,552.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,914.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,535.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,013.59
|
| Rate for Payer: Quartz Commercial |
$5,324.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,914.60
|
| Rate for Payer: The Alliance Commercial |
$32,764.00
|
| Rate for Payer: WEA Trust Commercial |
$4,505.05
|
| Rate for Payer: WPS Commercial |
$6,067.07
|
|
|
WEDGE CHRONOS BETA-TCP
|
Facility
IP
|
$8,191.00
|
|
| Hospital Charge Code |
2966591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,013.59 |
| Max. Negotiated Rate |
$7,535.72 |
| Rate for Payer: Aetna Commercial |
$7,371.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,341.23
|
| Rate for Payer: Cash Price |
$2,457.30
|
| Rate for Payer: Cigna Commercial |
$7,535.72
|
| Rate for Payer: Health EOS Commercial |
$7,289.99
|
| Rate for Payer: HFN Commercial |
$7,535.72
|
| Rate for Payer: Multiplan Commercial |
$6,552.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,914.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,535.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,013.59
|
| Rate for Payer: Quartz Commercial |
$4,914.60
|
| Rate for Payer: WEA Trust Commercial |
$4,505.05
|
| Rate for Payer: WPS Commercial |
$6,067.07
|
|
|
WEDGES MAKE UP LATEX
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
2970457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
WEDGES MAKE UP LATEX
|
Facility
IP
|
$3.00
|
|
| Hospital Charge Code |
2970457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
Welcome To Medicare Visit
|
Professional
|
$272.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
1122840
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$457.98 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$125.43
|
| Rate for Payer: Anthem Medicare Advantage |
$125.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.43
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.43
|
| Rate for Payer: Health EOS Commercial |
$247.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.43
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.40
|
| Rate for Payer: Quartz Beloit One Network |
$119.68
|
| Rate for Payer: Quartz Commercial |
$155.04
|
| Rate for Payer: Quartz Medicare Advantage |
$125.43
|
| Rate for Payer: The Alliance Commercial |
$344.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.43
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$219.50
|
|
