|
WASHER 3.5/4.0 SCREW 5881003540
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
WASHER 4.0MM ASNIS III SS 390018
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,724.00 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.19
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: The Alliance Commercial |
$1,724.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
WASHER 4.0MM ASNIS III SS 390018
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
WASHER 4MM BLUE HOFFMANN LIMB 4933-1-712
|
Facility
|
OP
|
$734.00
|
|
| Hospital Charge Code |
5611676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.52 |
| Max. Negotiated Rate |
$2,936.00 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Aetna Managed Medicare |
$205.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.75
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.50
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$477.10
|
| Rate for Payer: Quartz Medicare Advantage |
$440.40
|
| Rate for Payer: The Alliance Commercial |
$2,936.00
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
WASHER 4MM BLUE HOFFMANN LIMB 4933-1-712
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
5611676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.66 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$440.40
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
WASHER 6.5 CANN SCREW STERILE 04.353.907S
|
Facility
|
OP
|
$776.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$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 6.5 CANN SCREW STERILE 04.353.907S
|
Facility
|
IP
|
$776.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$380.71 |
| Max. Negotiated Rate |
$714.80 |
| Rate for Payer: Aetna Commercial |
$699.26
|
| Rate for Payer: 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 6.5MM 219.972
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
2967335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: 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 6.5MM 219.972
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2967335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
WASHER 7.0MM 219.98 (SM & MINI)
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
WASHER 7.0MM 219.98 (SM & MINI)
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: 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 7.0MM AR-8870W
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
WASHER 7.0MM AR-8870W
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.64
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$2,392.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
OP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.68 |
| Max. Negotiated Rate |
$2,824.00 |
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.16
|
| Rate for Payer: Aetna Managed Medicare |
$197.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.18
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$649.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.08
|
| Rate for Payer: Health EOS Commercial |
$628.34
|
| Rate for Payer: HFN Commercial |
$649.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.50
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: NAPHCARE Commercial |
$423.60
|
| Rate for Payer: Preferred Network Access Commercial |
$649.52
|
| Rate for Payer: Quartz Beloit One Network |
$345.94
|
| Rate for Payer: Quartz Commercial |
$458.90
|
| Rate for Payer: Quartz Medicare Advantage |
$423.60
|
| Rate for Payer: The Alliance Commercial |
$2,824.00
|
| Rate for Payer: WEA Trust Commercial |
$388.30
|
| Rate for Payer: WPS Commercial |
$522.93
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
IP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.94 |
| Max. Negotiated Rate |
$649.52 |
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.18
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$649.52
|
| Rate for Payer: Health EOS Commercial |
$628.34
|
| Rate for Payer: HFN Commercial |
$649.52
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: NAPHCARE Commercial |
$423.60
|
| Rate for Payer: Preferred Network Access Commercial |
$649.52
|
| Rate for Payer: Quartz Beloit One Network |
$345.94
|
| Rate for Payer: Quartz Commercial |
$423.60
|
| Rate for Payer: WEA Trust Commercial |
$388.30
|
| Rate for Payer: WPS Commercial |
$522.93
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.16 |
| Max. Negotiated Rate |
$2,588.00 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$181.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$362.06
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.25
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$420.55
|
| Rate for Payer: Quartz Medicare Advantage |
$388.20
|
| Rate for Payer: The Alliance Commercial |
$2,588.00
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$388.20
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
IP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
OP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.88 |
| Max. Negotiated Rate |
$6,284.00 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$439.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.13
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,178.25
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| Rate for Payer: Quartz Medicare Advantage |
$942.60
|
| Rate for Payer: The Alliance Commercial |
$6,284.00
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
OP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.92 |
| Max. Negotiated Rate |
$9,756.00 |
| Rate for Payer: Aetna Commercial |
$2,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.54
|
| Rate for Payer: Aetna Managed Medicare |
$682.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,170.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.67
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,243.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,364.86
|
| Rate for Payer: Health EOS Commercial |
$2,170.71
|
| Rate for Payer: HFN Commercial |
$2,243.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.25
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.11
|
| Rate for Payer: Quartz Commercial |
$1,585.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.40
|
| Rate for Payer: The Alliance Commercial |
$9,756.00
|
| Rate for Payer: WEA Trust Commercial |
$1,341.45
|
| Rate for Payer: WPS Commercial |
$1,806.57
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
IP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.11 |
| Max. Negotiated Rate |
$2,243.88 |
| Rate for Payer: Aetna Commercial |
$2,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.67
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,243.88
|
| Rate for Payer: Health EOS Commercial |
$2,170.71
|
| Rate for Payer: HFN Commercial |
$2,243.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.11
|
| Rate for Payer: Quartz Commercial |
$1,463.40
|
| Rate for Payer: WEA Trust Commercial |
$1,341.45
|
| Rate for Payer: WPS Commercial |
$1,806.57
|
|
|
WASHER STRYKER 619905
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.97 |
| Max. Negotiated Rate |
$416.76 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$271.80
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WASHER STRYKER 619905
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Aetna Managed Medicare |
$126.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.50
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$294.45
|
| Rate for Payer: Quartz Medicare Advantage |
$271.80
|
| Rate for Payer: The Alliance Commercial |
$1,812.00
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
