|
WALKERS & CANES-SP #11458
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2974082
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
WALKERS & CANES-SP #11458
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2974082
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
WAND HALO COBLATION WEREWOLF (T & A) 72290134
|
Facility
|
OP
|
$3,314.00
|
|
| Hospital Charge Code |
5977632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$927.92 |
| Max. Negotiated Rate |
$13,256.00 |
| Rate for Payer: Aetna Commercial |
$2,982.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,850.04
|
| Rate for Payer: Aetna Managed Medicare |
$927.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,154.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,657.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,590.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,756.42
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,048.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,854.51
|
| Rate for Payer: Health EOS Commercial |
$2,949.46
|
| Rate for Payer: HFN Commercial |
$3,048.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,485.50
|
| Rate for Payer: Multiplan Commercial |
$2,651.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,988.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,048.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,623.86
|
| Rate for Payer: Quartz Commercial |
$2,154.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,988.40
|
| Rate for Payer: The Alliance Commercial |
$13,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,822.70
|
| Rate for Payer: WPS Commercial |
$2,454.68
|
|
|
WAND HALO COBLATION WEREWOLF (T & A) 72290134
|
Facility
|
IP
|
$3,314.00
|
|
| Hospital Charge Code |
5977632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,623.86 |
| Max. Negotiated Rate |
$3,048.88 |
| Rate for Payer: Aetna Commercial |
$2,982.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,850.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,756.42
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,048.88
|
| Rate for Payer: Health EOS Commercial |
$2,949.46
|
| Rate for Payer: HFN Commercial |
$3,048.88
|
| Rate for Payer: Multiplan Commercial |
$2,651.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,988.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,048.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,623.86
|
| Rate for Payer: Quartz Commercial |
$1,988.40
|
| Rate for Payer: WEA Trust Commercial |
$1,822.70
|
| Rate for Payer: WPS Commercial |
$2,454.68
|
|
|
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 |
$1,488.13 |
| Max. Negotiated Rate |
$2,794.04 |
| Rate for Payer: Aetna Commercial |
$2,733.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,611.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,609.61
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,794.04
|
| Rate for Payer: Health EOS Commercial |
$2,702.93
|
| Rate for Payer: HFN Commercial |
$2,794.04
|
| Rate for Payer: Multiplan Commercial |
$2,429.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,822.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,794.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,488.13
|
| Rate for Payer: Quartz Commercial |
$1,822.20
|
| Rate for Payer: WEA Trust Commercial |
$1,670.35
|
| Rate for Payer: WPS Commercial |
$2,249.51
|
|
|
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 |
$850.36 |
| Max. Negotiated Rate |
$12,148.00 |
| Rate for Payer: Aetna Commercial |
$2,733.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,611.82
|
| Rate for Payer: Aetna Managed Medicare |
$850.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,974.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,518.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,457.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,609.61
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,794.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,699.51
|
| Rate for Payer: Health EOS Commercial |
$2,702.93
|
| Rate for Payer: HFN Commercial |
$2,794.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,277.75
|
| Rate for Payer: Multiplan Commercial |
$2,429.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,822.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,794.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,488.13
|
| Rate for Payer: Quartz Commercial |
$1,974.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,822.20
|
| Rate for Payer: The Alliance Commercial |
$12,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,670.35
|
| Rate for Payer: WPS Commercial |
$2,249.51
|
|
|
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 |
$1,531.25 |
| Max. Negotiated Rate |
$2,875.00 |
| Rate for Payer: Aetna Commercial |
$2,812.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,687.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,656.25
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: Health EOS Commercial |
$2,781.25
|
| Rate for Payer: HFN Commercial |
$2,875.00
|
| Rate for Payer: Multiplan Commercial |
$2,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,875.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,875.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,531.25
|
| Rate for Payer: Quartz Commercial |
$1,875.00
|
| Rate for Payer: WEA Trust Commercial |
$1,718.75
|
| Rate for Payer: WPS Commercial |
$2,314.69
|
|
|
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 |
$875.00 |
| Max. Negotiated Rate |
$12,500.00 |
| Rate for Payer: Aetna Commercial |
$2,812.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,687.50
|
| Rate for Payer: Aetna Managed Medicare |
$875.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,031.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,562.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,656.25
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$2,875.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,748.75
|
| Rate for Payer: Health EOS Commercial |
$2,781.25
|
| Rate for Payer: HFN Commercial |
$2,875.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,343.75
|
| Rate for Payer: Multiplan Commercial |
$2,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,875.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,875.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,531.25
|
| Rate for Payer: Quartz Commercial |
$2,031.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,875.00
|
| Rate for Payer: The Alliance Commercial |
$12,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,718.75
|
| Rate for Payer: WPS Commercial |
$2,314.69
|
|
|
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 |
$1,259.30 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,542.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
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 |
$719.60 |
| Max. Negotiated Rate |
$10,280.00 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Aetna Managed Medicare |
$719.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,670.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,285.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,438.17
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,927.50
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,670.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,542.00
|
| Rate for Payer: The Alliance Commercial |
$10,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
Warfarin, Serum/Plasma
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Warfarin, Serum/Plasma
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Warfarin, Serum/Plasma
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.40
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: The Alliance Commercial |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| 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
|
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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
WASHER 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: 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 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 |
$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 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: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
WASHER 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: Aetna Gatekeeper/Not Gatekeeper |
$583.94
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$668.19
|
| 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 3.0 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 |
$3,107.84 |
| 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: The Alliance Commercial |
$3,107.84
|
| 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 |
$2,056.00 |
| 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: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
