|
ZZZ***SCREW-CORT 3.5 X 36 204.036*** OBSOLETE *** USE 204.836
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 36 204.036*** OBSOLETE *** USE 204.836
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 38 204.038*** OBSOLETE *** USE 204.838
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 38 204.038*** OBSOLETE *** USE 204.838
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 40 204.040*** OBSOLETE *** USE 204.840
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 40 204.040*** OBSOLETE *** USE 204.840
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 45 204.045*** OBSOLETE *** USE 204.845
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 45 204.045*** OBSOLETE *** USE 204.845
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 48 204.048*** OBSOLETE *** USE 204.848
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 48 204.048*** OBSOLETE *** USE 204.848
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 50 204.050*** OBSOLETE *** USE 204.850
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 50 204.050*** OBSOLETE *** USE 204.850
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW CORT 4.5 X 60 214.060*** DISC***USE 214.860 ***
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
ZZZ***SCREW CORT 4.5 X 60 214.060*** DISC***USE 214.860 ***
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
zzzSCREW REMOVAL
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
zzzSCREW REMOVAL
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
zzzSET EPIDURAL PERIFIX 18GX3.5 332201 disc... see 1702391
|
Facility
|
OP
|
$262.00
|
|
| Hospital Charge Code |
4595215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
zzzSET EPIDURAL PERIFIX 18GX3.5 332201 disc... see 1702391
|
Facility
|
IP
|
$262.00
|
|
| Hospital Charge Code |
4595215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
zzzSHOULDER ACROMIOPLASTY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959779
|
|
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
|
|
|
zzzSHOULDER ACROMIOPLASTY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959779
|
|
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
|
|
|
zzzSHOULDER ARTHRODESIS
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959822
|
|
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
|
|
|
zzzSHOULDER ARTHRODESIS
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959822
|
|
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
|
|
|
zzzSHOULDER HEMIARTHROPLASTY
|
Facility
|
IP
|
$12,106.00
|
|
| Hospital Charge Code |
2960103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,169.22 |
| Max. Negotiated Rate |
$11,583.02 |
| Rate for Payer: Aetna Commercial |
$11,331.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,827.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,672.83
|
| Rate for Payer: Cash Price |
$3,631.80
|
| Rate for Payer: Cigna Commercial |
$11,583.02
|
| Rate for Payer: Health EOS Commercial |
$11,205.31
|
| Rate for Payer: HFN Commercial |
$11,583.02
|
| Rate for Payer: Multiplan Commercial |
$10,072.19
|
| Rate for Payer: Preferred Network Access Commercial |
$11,583.02
|
| Rate for Payer: Quartz Beloit One Network |
$6,169.22
|
| Rate for Payer: Quartz Commercial |
$7,554.14
|
| Rate for Payer: WEA Trust Commercial |
$6,924.63
|
| Rate for Payer: WPS Commercial |
$9,325.25
|
|
|
zzzSHOULDER HEMIARTHROPLASTY
|
Facility
|
OP
|
$12,106.00
|
|
| Hospital Charge Code |
2960103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,525.27 |
| Max. Negotiated Rate |
$11,583.02 |
| Rate for Payer: Aetna Commercial |
$11,331.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,827.61
|
| Rate for Payer: Aetna Managed Medicare |
$3,525.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,183.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,295.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,043.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,672.83
|
| Rate for Payer: Cash Price |
$3,631.80
|
| Rate for Payer: Cigna Commercial |
$11,583.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,045.69
|
| Rate for Payer: Health EOS Commercial |
$11,205.31
|
| Rate for Payer: HFN Commercial |
$11,583.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,442.68
|
| Rate for Payer: Multiplan Commercial |
$10,072.19
|
| Rate for Payer: NAPHCARE Commercial |
$7,554.14
|
| Rate for Payer: Preferred Network Access Commercial |
$11,583.02
|
| Rate for Payer: Quartz Beloit One Network |
$6,169.22
|
| Rate for Payer: Quartz Commercial |
$8,183.66
|
| Rate for Payer: Quartz Medicare Advantage |
$7,554.14
|
| Rate for Payer: The Alliance Commercial |
$6,295.12
|
| Rate for Payer: WEA Trust Commercial |
$6,924.63
|
| Rate for Payer: WPS Commercial |
$9,325.25
|
|
|
zzzSHOULDER MANIPULATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
