|
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
|
|
|
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
|
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
|
|
|
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
|
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
|
|
|
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
|
|
|
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 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 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
|
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
|
|
|
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 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
|
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: HFN Commercial |
$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: 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 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 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
|
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 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 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 6.5 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 6.5MM 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
|
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
|
|
