|
SHELL TRITANIUM CLUSTER HOLE 50MM D 502-03-50D
|
Facility
|
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3397502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 50MM D 502-03-50D
|
Facility
|
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3397502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 52MM D 502-03-52D
|
Facility
|
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3487507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 52MM D 502-03-52D
|
Facility
|
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3487507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 54MM E 502-03-54E
|
Facility
|
IP
|
$8,866.00
|
|
| Hospital Charge Code |
3693510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,344.34 |
| Max. Negotiated Rate |
$8,156.72 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 54MM E 502-03-54E
|
Facility
|
OP
|
$8,866.00
|
|
| Hospital Charge Code |
3693510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.48 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,961.41
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,649.50
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,762.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,319.60
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 56MM E 502-03-56E
|
Facility
|
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3949330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 56MM E 502-03-56E
|
Facility
|
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3949330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 58MM F 502-03-58F
|
Facility
|
IP
|
$8,866.00
|
|
| Hospital Charge Code |
4028638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,344.34 |
| Max. Negotiated Rate |
$8,156.72 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 58MM F 502-03-58F
|
Facility
|
OP
|
$8,866.00
|
|
| Hospital Charge Code |
4028638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.48 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,961.41
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,649.50
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,762.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,319.60
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 60MM F 502-03-60F
|
Facility
|
OP
|
$8,866.00
|
|
| Hospital Charge Code |
3779519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.48 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,961.41
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,649.50
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,762.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,319.60
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 60MM F 502-03-60F
|
Facility
|
IP
|
$8,866.00
|
|
| Hospital Charge Code |
3779519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,344.34 |
| Max. Negotiated Rate |
$8,156.72 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 62MM G 502-03-62G
|
Facility
|
OP
|
$8,538.00
|
|
| Hospital Charge Code |
4519927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 62MM G 502-03-62G
|
Facility
|
IP
|
$8,538.00
|
|
| Hospital Charge Code |
4519927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 64MM G 502-03-64G
|
Facility
|
OP
|
$8,538.00
|
|
| Hospital Charge Code |
4508737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 64MM G 502-03-64G
|
Facility
|
IP
|
$8,538.00
|
|
| Hospital Charge Code |
4508737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHIELD MINI
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2970868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
SHIELD MINI
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2970868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Shiga Toxin Antigen 2
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
4638624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.07
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.23
|
| Rate for Payer: Dean Health Medicaid |
$16.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.07
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.07
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.10
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.61
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16.07
|
| Rate for Payer: The Alliance Commercial |
$64.28
|
| Rate for Payer: United Healthcare Medicaid |
$16.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare PPO |
$84.75
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: WMAP Medicaid |
$16.61
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Shiga Toxin Antigen 2
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
4638624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna Commercial |
$107.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$107.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.80
|
| Rate for Payer: Health EOS Commercial |
$102.83
|
| Rate for Payer: HFN Commercial |
$107.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.73
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Preferred Network Access Commercial |
$107.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.72
|
| Rate for Payer: Quartz Commercial |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$56.50
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Shiga Toxin Antigen 2
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
4638624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Shiga Toxin Quest
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5474678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Shiga Toxin Quest
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5474678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Shiga Toxin Quest
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5474678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Shigella group B latex
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
634168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.38
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$26.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
