|
WALKER PNEUMANTIC AIR SMALL 15490005
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2974605
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.00
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$520.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
WALKER PNEUMAT AIR LG 15490067
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2974604
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
WALKER PNEUMAT AIR LG 15490067
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2974604
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
WALKERS & CANES-SP #11458
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2974082
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
WALKERS & CANES-SP #11458
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2974082
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
WAND HALO COBLATION WEREWOLF (T & A) 72290134
|
Facility
|
IP
|
$3,314.00
|
|
| Hospital Charge Code |
5977632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,688.81 |
| Max. Negotiated Rate |
$3,170.84 |
| Rate for Payer: Aetna Commercial |
$3,101.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.68
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,170.84
|
| Rate for Payer: Health EOS Commercial |
$3,067.44
|
| Rate for Payer: HFN Commercial |
$3,170.84
|
| Rate for Payer: Multiplan Commercial |
$2,757.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,170.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,688.81
|
| Rate for Payer: Quartz Commercial |
$2,067.94
|
| Rate for Payer: WEA Trust Commercial |
$1,895.61
|
| Rate for Payer: WPS Commercial |
$2,552.77
|
|
|
WAND HALO COBLATION WEREWOLF (T & A) 72290134
|
Facility
|
OP
|
$3,314.00
|
|
| Hospital Charge Code |
5977632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.04 |
| Max. Negotiated Rate |
$3,170.84 |
| Rate for Payer: Aetna Commercial |
$3,101.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Aetna Managed Medicare |
$965.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,240.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,723.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,654.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.68
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,170.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,928.75
|
| Rate for Payer: Health EOS Commercial |
$3,067.44
|
| Rate for Payer: HFN Commercial |
$3,170.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,584.92
|
| Rate for Payer: Multiplan Commercial |
$2,757.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,067.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,170.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,688.81
|
| Rate for Payer: Quartz Commercial |
$2,240.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,067.94
|
| Rate for Payer: The Alliance Commercial |
$1,723.28
|
| Rate for Payer: WEA Trust Commercial |
$1,895.61
|
| Rate for Payer: WPS Commercial |
$2,552.77
|
|
|
WAND PROCISE MAX COBLATION WITH INTEGRATED CABLE (ADENOID) EICA8898-01
|
Facility
|
OP
|
$3,037.00
|
|
| Hospital Charge Code |
5861692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$2,905.80 |
| Rate for Payer: Aetna Commercial |
$2,842.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,716.29
|
| Rate for Payer: Aetna Managed Medicare |
$884.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,053.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,579.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.99
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,905.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,767.53
|
| Rate for Payer: Health EOS Commercial |
$2,811.05
|
| Rate for Payer: HFN Commercial |
$2,905.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,368.86
|
| Rate for Payer: Multiplan Commercial |
$2,526.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,895.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,905.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.66
|
| Rate for Payer: Quartz Commercial |
$2,053.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,895.09
|
| Rate for Payer: The Alliance Commercial |
$1,579.24
|
| Rate for Payer: WEA Trust Commercial |
$1,737.16
|
| Rate for Payer: WPS Commercial |
$2,339.40
|
|
|
WAND PROCISE MAX COBLATION WITH INTEGRATED CABLE (ADENOID) EICA8898-01
|
Facility
|
IP
|
$3,037.00
|
|
| Hospital Charge Code |
5861692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,547.66 |
| Max. Negotiated Rate |
$2,905.80 |
| Rate for Payer: Aetna Commercial |
$2,842.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,716.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.99
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,905.80
|
| Rate for Payer: Health EOS Commercial |
$2,811.05
|
| Rate for Payer: HFN Commercial |
$2,905.80
|
| Rate for Payer: Multiplan Commercial |
$2,526.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,905.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.66
|
| Rate for Payer: Quartz Commercial |
$1,895.09
|
| Rate for Payer: WEA Trust Commercial |
$1,737.16
|
| Rate for Payer: WPS Commercial |
$2,339.40
|
|
|
WAND PROCISE XP WITH INTEGRATED CABLES (T&A) EICA8872-01
|
Facility
|
OP
|
$3,125.00
|
|
| Hospital Charge Code |
5415485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna Commercial |
$2,925.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,795.00
|
| Rate for Payer: Aetna Managed Medicare |
$910.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,112.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,560.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,722.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$2,990.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,818.75
|
| Rate for Payer: Health EOS Commercial |
$2,892.50
|
| Rate for Payer: HFN Commercial |
$2,990.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,437.50
|
| Rate for Payer: Multiplan Commercial |
$2,600.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,950.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,990.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,592.50
|
| Rate for Payer: Quartz Commercial |
$2,112.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,950.00
|
| Rate for Payer: The Alliance Commercial |
$1,625.00
|
| Rate for Payer: WEA Trust Commercial |
$1,787.50
|
| Rate for Payer: WPS Commercial |
$2,407.19
|
|
|
WAND PROCISE XP WITH INTEGRATED CABLES (T&A) EICA8872-01
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
5415485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,592.50 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna Commercial |
$2,925.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,795.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,722.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$2,990.00
|
| Rate for Payer: Health EOS Commercial |
$2,892.50
|
| Rate for Payer: HFN Commercial |
$2,990.00
|
| Rate for Payer: Multiplan Commercial |
$2,600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,990.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,592.50
|
| Rate for Payer: Quartz Commercial |
$1,950.00
|
| Rate for Payer: WEA Trust Commercial |
$1,787.50
|
| Rate for Payer: WPS Commercial |
$2,407.19
|
|
|
WAND REFLEX ULTRA PLASMA COBLATION PTR (SINUS) EICA4835-01
|
Facility
|
IP
|
$2,570.00
|
|
| Hospital Charge Code |
3301462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,603.68
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
WAND REFLEX ULTRA PLASMA COBLATION PTR (SINUS) EICA4835-01
|
Facility
|
OP
|
$2,570.00
|
|
| Hospital Charge Code |
3301462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.38 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Aetna Managed Medicare |
$748.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,737.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,282.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,495.74
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,004.60
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,603.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,737.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,603.68
|
| Rate for Payer: The Alliance Commercial |
$1,336.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
Warfarin, Serum/Plasma
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
Warfarin, Serum/Plasma
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$231.19 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$231.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$221.46
|
| Rate for Payer: HFN Commercial |
$231.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$231.19
|
| Rate for Payer: Quartz Beloit One Network |
$107.08
|
| Rate for Payer: Quartz Commercial |
$138.72
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Warfarin, Serum/Plasma
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
Warmer/Isolette - Daily Charges
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
3003955
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$167.23
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Warmer/Isolette - Nursery Daily Charges
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
3003947
|
|
Hospital Revenue Code
|
231
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$74.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$173.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.99
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.68
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$173.06
|
| Rate for Payer: Quartz Medicare Advantage |
$159.74
|
| Rate for Payer: The Alliance Commercial |
$133.12
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Warmer/Isolette - Nursery Daily Charges
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
3003947
|
|
Hospital Revenue Code
|
231
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$159.74
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
WASHER 10.00MM 219.91
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2967333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
WASHER 10.00MM 219.91
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2967333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
WASHER 13.0MM 219.99
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
WASHER 13.0MM 219.99
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$94.64
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
WASHER 2MM YELLOW HOFFMANN LIMB 4933-1-711
|
Facility
|
OP
|
$679.00
|
|
| Hospital Charge Code |
6226127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.72 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$635.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$459.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.26
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$649.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.18
|
| Rate for Payer: Health EOS Commercial |
$628.48
|
| Rate for Payer: HFN Commercial |
$649.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.62
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: NAPHCARE Commercial |
$423.70
|
| Rate for Payer: Preferred Network Access Commercial |
$649.67
|
| Rate for Payer: Quartz Beloit One Network |
$346.02
|
| Rate for Payer: Quartz Commercial |
$459.00
|
| Rate for Payer: Quartz Medicare Advantage |
$423.70
|
| Rate for Payer: The Alliance Commercial |
$353.08
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$523.03
|
|
|
WASHER 2MM YELLOW HOFFMANN LIMB 4933-1-711
|
Facility
|
IP
|
$679.00
|
|
| Hospital Charge Code |
6226127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.02 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$635.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.26
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$649.67
|
| Rate for Payer: Health EOS Commercial |
$628.48
|
| Rate for Payer: HFN Commercial |
$649.67
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: Preferred Network Access Commercial |
$649.67
|
| Rate for Payer: Quartz Beloit One Network |
$346.02
|
| Rate for Payer: Quartz Commercial |
$423.70
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$523.03
|
|
