|
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 |
$2,486.27 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,486.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,771.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,439.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,262.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,969.12
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,659.64
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: NAPHCARE Commercial |
$5,327.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,771.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5,327.71
|
| Rate for Payer: The Alliance Commercial |
$4,439.76
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$4,350.96 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,327.71
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$2,486.27 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,486.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,771.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,439.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,262.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,969.12
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,659.64
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: NAPHCARE Commercial |
$5,327.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,771.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5,327.71
|
| Rate for Payer: The Alliance Commercial |
$4,439.76
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$4,518.11 |
| Max. Negotiated Rate |
$8,482.99 |
| Rate for Payer: Aetna Commercial |
$8,298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,929.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,886.94
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,482.99
|
| Rate for Payer: Health EOS Commercial |
$8,206.37
|
| Rate for Payer: HFN Commercial |
$8,482.99
|
| Rate for Payer: Multiplan Commercial |
$7,376.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,482.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,518.11
|
| Rate for Payer: Quartz Commercial |
$5,532.38
|
| Rate for Payer: WEA Trust Commercial |
$5,071.35
|
| Rate for Payer: WPS Commercial |
$6,829.48
|
|
|
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 |
$2,581.78 |
| Max. Negotiated Rate |
$8,482.99 |
| Rate for Payer: Aetna Commercial |
$8,298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,929.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,581.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,993.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,610.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,425.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,886.94
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,482.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,160.01
|
| Rate for Payer: Health EOS Commercial |
$8,206.37
|
| Rate for Payer: HFN Commercial |
$8,482.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,915.48
|
| Rate for Payer: Multiplan Commercial |
$7,376.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,532.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,482.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,518.11
|
| Rate for Payer: Quartz Commercial |
$5,993.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,532.38
|
| Rate for Payer: The Alliance Commercial |
$4,610.32
|
| Rate for Payer: WEA Trust Commercial |
$5,071.35
|
| Rate for Payer: WPS Commercial |
$6,829.48
|
|
|
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 |
$4,350.96 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,327.71
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$2,486.27 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,486.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,771.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,439.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,262.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,969.12
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,659.64
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: NAPHCARE Commercial |
$5,327.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,771.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5,327.71
|
| Rate for Payer: The Alliance Commercial |
$4,439.76
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$4,518.11 |
| Max. Negotiated Rate |
$8,482.99 |
| Rate for Payer: Aetna Commercial |
$8,298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,929.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,886.94
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,482.99
|
| Rate for Payer: Health EOS Commercial |
$8,206.37
|
| Rate for Payer: HFN Commercial |
$8,482.99
|
| Rate for Payer: Multiplan Commercial |
$7,376.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,482.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,518.11
|
| Rate for Payer: Quartz Commercial |
$5,532.38
|
| Rate for Payer: WEA Trust Commercial |
$5,071.35
|
| Rate for Payer: WPS Commercial |
$6,829.48
|
|
|
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 |
$2,581.78 |
| Max. Negotiated Rate |
$8,482.99 |
| Rate for Payer: Aetna Commercial |
$8,298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,929.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,581.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,993.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,610.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,425.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,886.94
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,482.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,160.01
|
| Rate for Payer: Health EOS Commercial |
$8,206.37
|
| Rate for Payer: HFN Commercial |
$8,482.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,915.48
|
| Rate for Payer: Multiplan Commercial |
$7,376.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,532.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,482.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,518.11
|
| Rate for Payer: Quartz Commercial |
$5,993.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,532.38
|
| Rate for Payer: The Alliance Commercial |
$4,610.32
|
| Rate for Payer: WEA Trust Commercial |
$5,071.35
|
| Rate for Payer: WPS Commercial |
$6,829.48
|
|
|
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 |
$4,518.11 |
| Max. Negotiated Rate |
$8,482.99 |
| Rate for Payer: Aetna Commercial |
$8,298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,929.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,886.94
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,482.99
|
| Rate for Payer: Health EOS Commercial |
$8,206.37
|
| Rate for Payer: HFN Commercial |
$8,482.99
|
| Rate for Payer: Multiplan Commercial |
$7,376.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,482.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,518.11
|
| Rate for Payer: Quartz Commercial |
$5,532.38
|
| Rate for Payer: WEA Trust Commercial |
$5,071.35
|
| Rate for Payer: WPS Commercial |
$6,829.48
|
|
|
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 |
$2,581.78 |
| Max. Negotiated Rate |
$8,482.99 |
| Rate for Payer: Aetna Commercial |
$8,298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,929.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,581.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,993.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,610.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,425.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,886.94
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,482.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,160.01
|
| Rate for Payer: Health EOS Commercial |
$8,206.37
|
| Rate for Payer: HFN Commercial |
$8,482.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,915.48
|
| Rate for Payer: Multiplan Commercial |
$7,376.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,532.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,482.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,518.11
|
| Rate for Payer: Quartz Commercial |
$5,993.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,532.38
|
| Rate for Payer: The Alliance Commercial |
$4,610.32
|
| Rate for Payer: WEA Trust Commercial |
$5,071.35
|
| Rate for Payer: WPS Commercial |
$6,829.48
|
|
|
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 |
$2,486.27 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,486.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,771.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,439.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,262.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,969.12
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,659.64
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: NAPHCARE Commercial |
$5,327.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,771.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5,327.71
|
| Rate for Payer: The Alliance Commercial |
$4,439.76
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$4,350.96 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,327.71
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$4,350.96 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,327.71
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
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 |
$2,486.27 |
| Max. Negotiated Rate |
$8,169.16 |
| Rate for Payer: Aetna Commercial |
$7,991.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,636.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,486.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,771.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,439.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,262.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,706.15
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$8,169.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,969.12
|
| Rate for Payer: Health EOS Commercial |
$7,902.77
|
| Rate for Payer: HFN Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,659.64
|
| Rate for Payer: Multiplan Commercial |
$7,103.62
|
| Rate for Payer: NAPHCARE Commercial |
$5,327.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,169.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,350.96
|
| Rate for Payer: Quartz Commercial |
$5,771.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5,327.71
|
| Rate for Payer: The Alliance Commercial |
$4,439.76
|
| Rate for Payer: WEA Trust Commercial |
$4,883.74
|
| Rate for Payer: WPS Commercial |
$6,576.82
|
|
|
SHIELD MINI
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2970868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
SHIELD MINI
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2970868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Shiga Toxin Antigen 2
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
4638624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$111.64 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$111.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$106.94
|
| Rate for Payer: HFN Commercial |
$111.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$111.64
|
| Rate for Payer: Quartz Beloit One Network |
$51.71
|
| Rate for Payer: Quartz Commercial |
$66.99
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$73.54
|
|
|
Shiga Toxin Antigen 2
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
4638624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Shiga Toxin Antigen 2
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
4638624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$88.14
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Shiga Toxin Quest
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5474678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Shiga Toxin Quest
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5474678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Shiga Toxin Quest
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5474678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Shigella group B latex
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
634168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Shigella group B latex
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
634168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
