|
WASHER 7.0MM 219.98 (SM & MINI)
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2967336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
WASHER 7.0MM AR-8870W
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
WASHER 7.0MM AR-8870W
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$310.96
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
OP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.59 |
| Max. Negotiated Rate |
$675.50 |
| Rate for Payer: Aetna Commercial |
$660.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.45
|
| Rate for Payer: Aetna Managed Medicare |
$205.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.15
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$675.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.89
|
| Rate for Payer: Health EOS Commercial |
$653.47
|
| Rate for Payer: HFN Commercial |
$675.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.68
|
| Rate for Payer: Multiplan Commercial |
$587.39
|
| Rate for Payer: NAPHCARE Commercial |
$440.54
|
| Rate for Payer: Preferred Network Access Commercial |
$675.50
|
| Rate for Payer: Quartz Beloit One Network |
$359.78
|
| Rate for Payer: Quartz Commercial |
$477.26
|
| Rate for Payer: Quartz Medicare Advantage |
$440.54
|
| Rate for Payer: The Alliance Commercial |
$367.12
|
| Rate for Payer: WEA Trust Commercial |
$403.83
|
| Rate for Payer: WPS Commercial |
$543.83
|
|
|
WASHER 7MM RED HOFFMANN LIMB 4933-1-713
|
Facility
|
IP
|
$706.00
|
|
| Hospital Charge Code |
6001645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.78 |
| Max. Negotiated Rate |
$675.50 |
| Rate for Payer: Aetna Commercial |
$660.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.15
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$675.50
|
| Rate for Payer: Health EOS Commercial |
$653.47
|
| Rate for Payer: HFN Commercial |
$675.50
|
| Rate for Payer: Multiplan Commercial |
$587.39
|
| Rate for Payer: Preferred Network Access Commercial |
$675.50
|
| Rate for Payer: Quartz Beloit One Network |
$359.78
|
| Rate for Payer: Quartz Commercial |
$440.54
|
| Rate for Payer: WEA Trust Commercial |
$403.83
|
| Rate for Payer: WPS Commercial |
$543.83
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
OP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$188.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$437.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.55
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.66
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$403.73
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$437.37
|
| Rate for Payer: Quartz Medicare Advantage |
$403.73
|
| Rate for Payer: The Alliance Commercial |
$336.44
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
WASHER AMBI CANN SCREW 121680
|
Facility
|
IP
|
$647.00
|
|
| Hospital Charge Code |
2966057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$329.71 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$403.73
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
IP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.58 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$980.30
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
WASHER SPIKED 13.5/6.5MM 219.951
|
Facility
|
OP
|
$1,571.00
|
|
| Hospital Charge Code |
2967337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.48 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$457.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,062.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$784.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.32
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.38
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$980.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$1,062.00
|
| Rate for Payer: Quartz Medicare Advantage |
$980.30
|
| Rate for Payer: The Alliance Commercial |
$816.92
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
IP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.91 |
| Max. Negotiated Rate |
$2,333.64 |
| Rate for Payer: Aetna Commercial |
$2,282.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.38
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,333.64
|
| Rate for Payer: Health EOS Commercial |
$2,257.54
|
| Rate for Payer: HFN Commercial |
$2,333.64
|
| Rate for Payer: Multiplan Commercial |
$2,029.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.91
|
| Rate for Payer: Quartz Commercial |
$1,521.94
|
| Rate for Payer: WEA Trust Commercial |
$1,395.11
|
| Rate for Payer: WPS Commercial |
$1,878.76
|
|
|
WASHER SPIKED ACHILLES 303-50-004
|
Facility
|
OP
|
$2,439.00
|
|
| Hospital Charge Code |
4383170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.24 |
| Max. Negotiated Rate |
$2,333.64 |
| Rate for Payer: Aetna Commercial |
$2,282.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.44
|
| Rate for Payer: Aetna Managed Medicare |
$710.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.38
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,333.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.50
|
| Rate for Payer: Health EOS Commercial |
$2,257.54
|
| Rate for Payer: HFN Commercial |
$2,333.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.42
|
| Rate for Payer: Multiplan Commercial |
$2,029.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.91
|
| Rate for Payer: Quartz Commercial |
$1,648.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.94
|
| Rate for Payer: The Alliance Commercial |
$1,268.28
|
| Rate for Payer: WEA Trust Commercial |
$1,395.11
|
| Rate for Payer: WPS Commercial |
$1,878.76
|
|
|
WASHER STRYKER 619905
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$282.67
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
WASHER STRYKER 619905
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.91 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Aetna Managed Medicare |
$131.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.65
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$353.34
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: NAPHCARE Commercial |
$282.67
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$306.23
|
| Rate for Payer: Quartz Medicare Advantage |
$282.67
|
| Rate for Payer: The Alliance Commercial |
$235.56
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
WASHER THREADED 219.89
|
Facility
|
OP
|
$791.00
|
|
| Hospital Charge Code |
2967338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$756.83 |
| Rate for Payer: Aetna Commercial |
$740.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Aetna Managed Medicare |
$230.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.00
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.36
|
| Rate for Payer: Health EOS Commercial |
$732.15
|
| Rate for Payer: HFN Commercial |
$756.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.98
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: NAPHCARE Commercial |
$493.58
|
| Rate for Payer: Preferred Network Access Commercial |
$756.83
|
| Rate for Payer: Quartz Beloit One Network |
$403.09
|
| Rate for Payer: Quartz Commercial |
$534.72
|
| Rate for Payer: Quartz Medicare Advantage |
$493.58
|
| Rate for Payer: The Alliance Commercial |
$411.32
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
WASHER THREADED 219.89
|
Facility
|
IP
|
$791.00
|
|
| Hospital Charge Code |
2967338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.09 |
| Max. Negotiated Rate |
$756.83 |
| Rate for Payer: Aetna Commercial |
$740.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.00
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: Health EOS Commercial |
$732.15
|
| Rate for Payer: HFN Commercial |
$756.83
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: Preferred Network Access Commercial |
$756.83
|
| Rate for Payer: Quartz Beloit One Network |
$403.09
|
| Rate for Payer: Quartz Commercial |
$493.58
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
WASTE BAG 10 L CELL SAVER CSE-B-1000
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
5810149
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.82
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
WASTE BAG 10 L CELL SAVER CSE-B-1000
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
5810149
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
WEARABLE DEFIBRILLATOR SYSTEM 93292
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 93292
|
| Hospital Charge Code |
3015364
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$316.16 |
| Rate for Payer: Aetna Commercial |
$316.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$51.41
|
| Rate for Payer: Anthem Medicare Advantage |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.41
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$316.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.41
|
| Rate for Payer: Health EOS Commercial |
$302.85
|
| Rate for Payer: HFN Commercial |
$316.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$174.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.41
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$77.11
|
| Rate for Payer: Preferred Network Access Commercial |
$316.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.43
|
| Rate for Payer: Quartz Commercial |
$189.70
|
| Rate for Payer: Quartz Medicare Advantage |
$51.41
|
| Rate for Payer: The Alliance Commercial |
$195.35
|
| Rate for Payer: United Healthcare Medicaid |
$36.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.41
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$205.63
|
|
|
Wearable ECG Monitor/Report,24Hrs,W/ Superimp Scan Interp;Phys
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
1188827
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$835.85 |
| Rate for Payer: Aetna Commercial |
$835.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$835.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$800.65
|
| Rate for Payer: HFN Commercial |
$835.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$703.87
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$835.85
|
| Rate for Payer: Quartz Beloit One Network |
$387.13
|
| Rate for Payer: Quartz Commercial |
$501.51
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Medicaid |
$28.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$483.91
|
| Rate for Payer: WPS Commercial |
$71.84
|
|
|
WEAVER DUNN PROCEDURE
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
WEAVER DUNN PROCEDURE
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
WEDGE CHRONOS BETA-TCP
|
Facility
|
OP
|
$8,191.00
|
|
| Hospital Charge Code |
2966591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,385.22 |
| Max. Negotiated Rate |
$7,837.15 |
| Rate for Payer: Aetna Commercial |
$7,666.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,326.03
|
| Rate for Payer: Aetna Managed Medicare |
$2,385.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,537.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,259.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,088.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,514.88
|
| Rate for Payer: Cash Price |
$2,457.30
|
| Rate for Payer: Cigna Commercial |
$7,837.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,767.16
|
| Rate for Payer: Health EOS Commercial |
$7,581.59
|
| Rate for Payer: HFN Commercial |
$7,837.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,388.98
|
| Rate for Payer: Multiplan Commercial |
$6,814.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,111.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,837.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,174.13
|
| Rate for Payer: Quartz Commercial |
$5,537.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5,111.18
|
| Rate for Payer: The Alliance Commercial |
$4,259.32
|
| Rate for Payer: WEA Trust Commercial |
$4,685.25
|
| Rate for Payer: WPS Commercial |
$6,309.53
|
|
|
WEDGE CHRONOS BETA-TCP
|
Facility
|
IP
|
$8,191.00
|
|
| Hospital Charge Code |
2966591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,174.13 |
| Max. Negotiated Rate |
$7,837.15 |
| Rate for Payer: Aetna Commercial |
$7,666.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,326.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,514.88
|
| Rate for Payer: Cash Price |
$2,457.30
|
| Rate for Payer: Cigna Commercial |
$7,837.15
|
| Rate for Payer: Health EOS Commercial |
$7,581.59
|
| Rate for Payer: HFN Commercial |
$7,837.15
|
| Rate for Payer: Multiplan Commercial |
$6,814.91
|
| Rate for Payer: Preferred Network Access Commercial |
$7,837.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,174.13
|
| Rate for Payer: Quartz Commercial |
$5,111.18
|
| Rate for Payer: WEA Trust Commercial |
$4,685.25
|
| Rate for Payer: WPS Commercial |
$6,309.53
|
|
