|
BUR 4.5 ROUND H9111
|
Facility
IP
|
$991.00
|
|
| Hospital Charge Code |
2964875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BUR 4.5 ROUND H9111
|
Facility
OP
|
$991.00
|
|
| Hospital Charge Code |
2964875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BUR 4.8 ROUND 1608-006-139
|
Facility
OP
|
$1,147.00
|
|
| Hospital Charge Code |
2966113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.16 |
| Max. Negotiated Rate |
$4,588.00 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Aetna Managed Medicare |
$321.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$745.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$573.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$550.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.86
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.25
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$688.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$745.55
|
| Rate for Payer: Quartz Medicare Advantage |
$688.20
|
| Rate for Payer: The Alliance Commercial |
$4,588.00
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
BUR 4.8 ROUND 1608-006-139
|
Facility
IP
|
$1,147.00
|
|
| Hospital Charge Code |
2966113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.03 |
| Max. Negotiated Rate |
$1,055.24 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$688.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$688.20
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
BUR 4X48 ROUND CARBIDE
|
Facility
OP
|
$1,484.00
|
|
| Hospital Charge Code |
2964898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.52 |
| Max. Negotiated Rate |
$5,936.00 |
| Rate for Payer: Aetna Commercial |
$1,335.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.24
|
| Rate for Payer: Aetna Managed Medicare |
$415.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$964.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$712.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.52
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,365.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$830.45
|
| Rate for Payer: Health EOS Commercial |
$1,320.76
|
| Rate for Payer: HFN Commercial |
$1,365.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,113.00
|
| Rate for Payer: Multiplan Commercial |
$1,187.20
|
| Rate for Payer: NAPHCARE Commercial |
$890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.28
|
| Rate for Payer: Quartz Beloit One Network |
$727.16
|
| Rate for Payer: Quartz Commercial |
$964.60
|
| Rate for Payer: Quartz Medicare Advantage |
$890.40
|
| Rate for Payer: The Alliance Commercial |
$5,936.00
|
| Rate for Payer: WEA Trust Commercial |
$816.20
|
| Rate for Payer: WPS Commercial |
$1,099.20
|
|
|
BUR 4X48 ROUND CARBIDE
|
Facility
IP
|
$1,484.00
|
|
| Hospital Charge Code |
2964898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$727.16 |
| Max. Negotiated Rate |
$1,365.28 |
| Rate for Payer: Aetna Commercial |
$1,335.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.52
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,365.28
|
| Rate for Payer: Health EOS Commercial |
$1,320.76
|
| Rate for Payer: HFN Commercial |
$1,365.28
|
| Rate for Payer: Multiplan Commercial |
$1,187.20
|
| Rate for Payer: NAPHCARE Commercial |
$890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.28
|
| Rate for Payer: Quartz Beloit One Network |
$727.16
|
| Rate for Payer: Quartz Commercial |
$890.40
|
| Rate for Payer: WEA Trust Commercial |
$816.20
|
| Rate for Payer: WPS Commercial |
$1,099.20
|
|
|
BUR 5.5 CYCLONE H9119
|
Facility
OP
|
$991.00
|
|
| Hospital Charge Code |
2964876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BUR 5.5 CYCLONE H9119
|
Facility
IP
|
$991.00
|
|
| Hospital Charge Code |
2964876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BUR 5.5MM X 13CM OVAL 12 FLUTED ARTHROSCOPY ARTHREX AR-8550OBT
|
Facility
IP
|
$925.00
|
|
| Hospital Charge Code |
5074896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
BUR 5.5MM X 13CM OVAL 12 FLUTED ARTHROSCOPY ARTHREX AR-8550OBT
|
Facility
OP
|
$925.00
|
|
| Hospital Charge Code |
5074896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$555.00
|
| Rate for Payer: The Alliance Commercial |
$3,700.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
BUR 5.5 ROUND 1608-006-141
|
Facility
IP
|
$1,147.00
|
|
| Hospital Charge Code |
2966114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.03 |
| Max. Negotiated Rate |
$1,055.24 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$688.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$688.20
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
BUR 5.5 ROUND 1608-006-141
|
Facility
OP
|
$1,147.00
|
|
| Hospital Charge Code |
2966114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.16 |
| Max. Negotiated Rate |
$4,588.00 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Aetna Managed Medicare |
$321.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$745.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$573.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$550.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.86
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.25
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$688.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$745.55
|
| Rate for Payer: Quartz Medicare Advantage |
$688.20
|
| Rate for Payer: The Alliance Commercial |
$4,588.00
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
BUR 5x38 ROUND CARBIDE LSO
|
Facility
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.98 |
| Max. Negotiated Rate |
$1,473.84 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$961.20
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
BUR 5x38 ROUND CARBIDE LSO
|
Facility
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.56 |
| Max. Negotiated Rate |
$6,408.00 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Aetna Managed Medicare |
$448.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,041.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$896.48
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.50
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$1,041.30
|
| Rate for Payer: Quartz Medicare Advantage |
$961.20
|
| Rate for Payer: The Alliance Commercial |
$6,408.00
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
BUR 6.0MM EGG 1607-002-003
|
Facility
OP
|
$1,065.00
|
|
| Hospital Charge Code |
2975078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.90
|
| Rate for Payer: Aetna Managed Medicare |
$298.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$532.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.45
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$979.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.97
|
| Rate for Payer: Health EOS Commercial |
$947.85
|
| Rate for Payer: HFN Commercial |
$979.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$798.75
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: NAPHCARE Commercial |
$639.00
|
| Rate for Payer: Preferred Network Access Commercial |
$979.80
|
| Rate for Payer: Quartz Beloit One Network |
$521.85
|
| Rate for Payer: Quartz Commercial |
$692.25
|
| Rate for Payer: Quartz Medicare Advantage |
$639.00
|
| Rate for Payer: The Alliance Commercial |
$4,260.00
|
| Rate for Payer: WEA Trust Commercial |
$585.75
|
| Rate for Payer: WPS Commercial |
$788.85
|
|
|
BUR 6.0MM EGG 1607-002-003
|
Facility
IP
|
$1,065.00
|
|
| Hospital Charge Code |
2975078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.85 |
| Max. Negotiated Rate |
$979.80 |
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.45
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$979.80
|
| Rate for Payer: Health EOS Commercial |
$947.85
|
| Rate for Payer: HFN Commercial |
$979.80
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: NAPHCARE Commercial |
$639.00
|
| Rate for Payer: Preferred Network Access Commercial |
$979.80
|
| Rate for Payer: Quartz Beloit One Network |
$521.85
|
| Rate for Payer: Quartz Commercial |
$639.00
|
| Rate for Payer: WEA Trust Commercial |
$585.75
|
| Rate for Payer: WPS Commercial |
$788.85
|
|
|
BUR 6.0 OVAL H9102
|
Facility
OP
|
$991.00
|
|
| Hospital Charge Code |
2964877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BUR 6.0 OVAL H9102
|
Facility
IP
|
$991.00
|
|
| Hospital Charge Code |
2964877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BUR 6.3MM ROUND 1608-006-143
|
Facility
IP
|
$1,097.00
|
|
| Hospital Charge Code |
2966116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.53 |
| Max. Negotiated Rate |
$1,009.24 |
| Rate for Payer: Aetna Commercial |
$987.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.41
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,009.24
|
| Rate for Payer: Health EOS Commercial |
$976.33
|
| Rate for Payer: HFN Commercial |
$1,009.24
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: NAPHCARE Commercial |
$658.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.24
|
| Rate for Payer: Quartz Beloit One Network |
$537.53
|
| Rate for Payer: Quartz Commercial |
$658.20
|
| Rate for Payer: WEA Trust Commercial |
$603.35
|
| Rate for Payer: WPS Commercial |
$812.55
|
|
|
BUR 6.3MM ROUND 1608-006-143
|
Facility
OP
|
$1,097.00
|
|
| Hospital Charge Code |
2966116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.16 |
| Max. Negotiated Rate |
$4,388.00 |
| Rate for Payer: Aetna Commercial |
$987.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$943.42
|
| Rate for Payer: Aetna Managed Medicare |
$307.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$713.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$526.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.41
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,009.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$613.88
|
| Rate for Payer: Health EOS Commercial |
$976.33
|
| Rate for Payer: HFN Commercial |
$1,009.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$822.75
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: NAPHCARE Commercial |
$658.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.24
|
| Rate for Payer: Quartz Beloit One Network |
$537.53
|
| Rate for Payer: Quartz Commercial |
$713.05
|
| Rate for Payer: Quartz Medicare Advantage |
$658.20
|
| Rate for Payer: The Alliance Commercial |
$4,388.00
|
| Rate for Payer: WEA Trust Commercial |
$603.35
|
| Rate for Payer: WPS Commercial |
$812.55
|
|
|
BUR 6MM DIAMOND E6160
|
Facility
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2969486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,042.80
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
|
BUR 6MM DIAMOND E6160
|
Facility
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2969486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.64 |
| Max. Negotiated Rate |
$6,952.00 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| Rate for Payer: Aetna Managed Medicare |
$486.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,129.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$869.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$834.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$972.58
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,303.50
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,129.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,042.80
|
| Rate for Payer: The Alliance Commercial |
$6,952.00
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
|
BUR 8.0 ROUND 1607-002-041
|
Facility
IP
|
$1,188.00
|
|
| Hospital Charge Code |
2966117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BUR 8.0 ROUND 1607-002-041
|
Facility
OP
|
$1,188.00
|
|
| Hospital Charge Code |
2966117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$4,752.00 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$772.20
|
| Rate for Payer: Quartz Medicare Advantage |
$712.80
|
| Rate for Payer: The Alliance Commercial |
$4,752.00
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BUR CARBIDE 0.6 #31-55363
|
Facility
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2965325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.64 |
| Max. Negotiated Rate |
$6,952.00 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| Rate for Payer: Aetna Managed Medicare |
$486.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,129.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$869.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$834.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$972.58
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,303.50
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,129.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,042.80
|
| Rate for Payer: The Alliance Commercial |
$6,952.00
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
