|
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 |
$226.25 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna Commercial |
$727.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.91
|
| Rate for Payer: Aetna Managed Medicare |
$226.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.26
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$743.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.19
|
| Rate for Payer: Health EOS Commercial |
$719.15
|
| Rate for Payer: HFN Commercial |
$743.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.03
|
| Rate for Payer: Multiplan Commercial |
$646.43
|
| Rate for Payer: NAPHCARE Commercial |
$484.82
|
| Rate for Payer: Preferred Network Access Commercial |
$743.40
|
| Rate for Payer: Quartz Beloit One Network |
$395.94
|
| Rate for Payer: Quartz Commercial |
$525.22
|
| Rate for Payer: Quartz Medicare Advantage |
$484.82
|
| Rate for Payer: The Alliance Commercial |
$404.02
|
| Rate for Payer: WEA Trust Commercial |
$444.42
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
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 |
$395.94 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna Commercial |
$727.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.26
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$743.40
|
| Rate for Payer: Health EOS Commercial |
$719.15
|
| Rate for Payer: HFN Commercial |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$646.43
|
| Rate for Payer: Preferred Network Access Commercial |
$743.40
|
| Rate for Payer: Quartz Beloit One Network |
$395.94
|
| Rate for Payer: Quartz Commercial |
$484.82
|
| Rate for Payer: WEA Trust Commercial |
$444.42
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
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 |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
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 |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
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 |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
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 |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
WASHER 4MM BLUE HOFFMANN LIMB 4933-1-712
|
Facility
|
OP
|
$734.00
|
|
| Hospital Charge Code |
5611676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.74 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Aetna Managed Medicare |
$213.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$496.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$366.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$702.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.19
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$572.52
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: NAPHCARE Commercial |
$458.02
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$496.18
|
| Rate for Payer: Quartz Medicare Advantage |
$458.02
|
| Rate for Payer: The Alliance Commercial |
$381.68
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
|
WASHER 4MM BLUE HOFFMANN LIMB 4933-1-712
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
5611676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$702.29
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$458.02
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
|
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 |
$395.94 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna Commercial |
$727.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.26
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$743.40
|
| Rate for Payer: Health EOS Commercial |
$719.15
|
| Rate for Payer: HFN Commercial |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$646.43
|
| Rate for Payer: Preferred Network Access Commercial |
$743.40
|
| Rate for Payer: Quartz Beloit One Network |
$395.94
|
| Rate for Payer: Quartz Commercial |
$484.82
|
| Rate for Payer: WEA Trust Commercial |
$444.42
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
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 |
$226.25 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna Commercial |
$727.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.91
|
| Rate for Payer: Aetna Managed Medicare |
$226.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.26
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cigna Commercial |
$743.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.19
|
| Rate for Payer: Health EOS Commercial |
$719.15
|
| Rate for Payer: HFN Commercial |
$743.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.03
|
| Rate for Payer: Multiplan Commercial |
$646.43
|
| Rate for Payer: NAPHCARE Commercial |
$484.82
|
| Rate for Payer: Preferred Network Access Commercial |
$743.40
|
| Rate for Payer: Quartz Beloit One Network |
$395.94
|
| Rate for Payer: Quartz Commercial |
$525.22
|
| Rate for Payer: Quartz Medicare Advantage |
$484.82
|
| Rate for Payer: The Alliance Commercial |
$404.02
|
| Rate for Payer: WEA Trust Commercial |
$444.42
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
WASHER 6.5MM 219.972
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2967335
|
|
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 6.5MM 219.972
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
2967335
|
|
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 7.0MM 219.98 (SM & MINI)
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
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 7.0MM 219.98 (SM & MINI)
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
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 7.0MM AR-8870W
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
WASHER 7.0MM AR-8870W
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$310.96
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
IP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.78 |
| Max. Negotiated Rate |
$675.50 |
| Rate for Payer: Aetna Commercial |
$660.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.15
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$675.50
|
| Rate for Payer: Health EOS Commercial |
$653.47
|
| Rate for Payer: HFN Commercial |
$675.50
|
| Rate for Payer: Multiplan Commercial |
$587.39
|
| Rate for Payer: Preferred Network Access Commercial |
$675.50
|
| Rate for Payer: Quartz Beloit One Network |
$359.78
|
| Rate for Payer: Quartz Commercial |
$440.54
|
| Rate for Payer: WEA Trust Commercial |
$403.83
|
| Rate for Payer: WPS Commercial |
$543.83
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
OP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.59 |
| Max. Negotiated Rate |
$675.50 |
| Rate for Payer: Aetna Commercial |
$660.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.45
|
| Rate for Payer: Aetna Managed Medicare |
$205.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.15
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$675.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.89
|
| Rate for Payer: Health EOS Commercial |
$653.47
|
| Rate for Payer: HFN Commercial |
$675.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.68
|
| Rate for Payer: Multiplan Commercial |
$587.39
|
| Rate for Payer: NAPHCARE Commercial |
$440.54
|
| Rate for Payer: Preferred Network Access Commercial |
$675.50
|
| Rate for Payer: Quartz Beloit One Network |
$359.78
|
| Rate for Payer: Quartz Commercial |
$477.26
|
| Rate for Payer: Quartz Medicare Advantage |
$440.54
|
| Rate for Payer: The Alliance Commercial |
$367.12
|
| Rate for Payer: WEA Trust Commercial |
$403.83
|
| Rate for Payer: WPS Commercial |
$543.83
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$329.71 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$403.73
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$188.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$437.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.55
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.66
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$403.73
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$437.37
|
| Rate for Payer: Quartz Medicare Advantage |
$403.73
|
| Rate for Payer: The Alliance Commercial |
$336.44
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
IP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.58 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$980.30
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
OP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.48 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$457.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,062.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$784.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.32
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.38
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$980.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$1,062.00
|
| Rate for Payer: Quartz Medicare Advantage |
$980.30
|
| Rate for Payer: The Alliance Commercial |
$816.92
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
IP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.91 |
| Max. Negotiated Rate |
$2,333.64 |
| Rate for Payer: Aetna Commercial |
$2,282.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.38
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,333.64
|
| Rate for Payer: Health EOS Commercial |
$2,257.54
|
| Rate for Payer: HFN Commercial |
$2,333.64
|
| Rate for Payer: Multiplan Commercial |
$2,029.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.91
|
| Rate for Payer: Quartz Commercial |
$1,521.94
|
| Rate for Payer: WEA Trust Commercial |
$1,395.11
|
| Rate for Payer: WPS Commercial |
$1,878.76
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
OP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.24 |
| Max. Negotiated Rate |
$2,333.64 |
| Rate for Payer: Aetna Commercial |
$2,282.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.44
|
| Rate for Payer: Aetna Managed Medicare |
$710.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.38
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,333.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.50
|
| Rate for Payer: Health EOS Commercial |
$2,257.54
|
| Rate for Payer: HFN Commercial |
$2,333.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.42
|
| Rate for Payer: Multiplan Commercial |
$2,029.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.91
|
| Rate for Payer: Quartz Commercial |
$1,648.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.94
|
| Rate for Payer: The Alliance Commercial |
$1,268.28
|
| Rate for Payer: WEA Trust Commercial |
$1,395.11
|
| Rate for Payer: WPS Commercial |
$1,878.76
|
|
|
WASHER STRYKER 619905
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.91 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Aetna Managed Medicare |
$131.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.65
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$353.34
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: NAPHCARE Commercial |
$282.67
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$306.23
|
| Rate for Payer: Quartz Medicare Advantage |
$282.67
|
| Rate for Payer: The Alliance Commercial |
$235.56
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
