|
BUR 3X48 DIAMOND ROUND E5230
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2969485
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| 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 3x48 ROUND DIAMOND CRS
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2969469
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| 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 3x48 ROUND DIAMOND CRS
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2969469
|
|
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 4.0MM EGG 1607-002-035
|
Facility
|
IP
|
$1,107.00
|
|
| Hospital Charge Code |
2966111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.43 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.71
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,018.44
|
| Rate for Payer: Health EOS Commercial |
$985.23
|
| Rate for Payer: HFN Commercial |
$1,018.44
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: NAPHCARE Commercial |
$664.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.44
|
| Rate for Payer: Quartz Beloit One Network |
$542.43
|
| Rate for Payer: Quartz Commercial |
$664.20
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
BUR 4.0MM EGG 1607-002-035
|
Facility
|
OP
|
$1,107.00
|
|
| Hospital Charge Code |
2966111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.96 |
| Max. Negotiated Rate |
$4,428.00 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Aetna Managed Medicare |
$309.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$719.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$553.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$531.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.71
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,018.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.48
|
| Rate for Payer: Health EOS Commercial |
$985.23
|
| Rate for Payer: HFN Commercial |
$1,018.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$830.25
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: NAPHCARE Commercial |
$664.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.44
|
| Rate for Payer: Quartz Beloit One Network |
$542.43
|
| Rate for Payer: Quartz Commercial |
$719.55
|
| Rate for Payer: Quartz Medicare Advantage |
$664.20
|
| Rate for Payer: The Alliance Commercial |
$4,428.00
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
BUR 4.0MM X 18CM ROUND 8 FLUTE RETRACT ARTHROSCOPY AR-6400RRBE
|
Facility
|
IP
|
$1,345.00
|
|
| Hospital Charge Code |
5563401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.05 |
| Max. Negotiated Rate |
$1,237.40 |
| Rate for Payer: Aetna Commercial |
$1,210.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,156.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.85
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cigna Commercial |
$1,237.40
|
| Rate for Payer: Health EOS Commercial |
$1,197.05
|
| Rate for Payer: HFN Commercial |
$1,237.40
|
| Rate for Payer: Multiplan Commercial |
$1,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$807.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,237.40
|
| Rate for Payer: Quartz Beloit One Network |
$659.05
|
| Rate for Payer: Quartz Commercial |
$807.00
|
| Rate for Payer: WEA Trust Commercial |
$739.75
|
| Rate for Payer: WPS Commercial |
$996.24
|
|
|
BUR 4.0MM X 18CM ROUND 8 FLUTE RETRACT ARTHROSCOPY AR-6400RRBE
|
Facility
|
OP
|
$1,345.00
|
|
| Hospital Charge Code |
5563401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.60 |
| Max. Negotiated Rate |
$5,380.00 |
| Rate for Payer: Aetna Commercial |
$1,210.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,156.70
|
| Rate for Payer: Aetna Managed Medicare |
$376.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$672.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$645.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.85
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cigna Commercial |
$1,237.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$752.66
|
| Rate for Payer: Health EOS Commercial |
$1,197.05
|
| Rate for Payer: HFN Commercial |
$1,237.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.75
|
| Rate for Payer: Multiplan Commercial |
$1,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$807.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,237.40
|
| Rate for Payer: Quartz Beloit One Network |
$659.05
|
| Rate for Payer: Quartz Commercial |
$874.25
|
| Rate for Payer: Quartz Medicare Advantage |
$807.00
|
| Rate for Payer: The Alliance Commercial |
$5,380.00
|
| Rate for Payer: WEA Trust Commercial |
$739.75
|
| Rate for Payer: WPS Commercial |
$996.24
|
|
|
BUR 4.0 OVAL H9101
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| 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 4.0 OVAL H9101
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965527
|
|
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 4.0 OVAL SOLID CARBIDE LONG 5300-020-901
|
Facility
|
IP
|
$650.00
|
|
| Hospital Charge Code |
5563745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$390.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
BUR 4.0 OVAL SOLID CARBIDE LONG 5300-020-901
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
5563745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Aetna Managed Medicare |
$182.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$422.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.74
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.50
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$422.50
|
| Rate for Payer: Quartz Medicare Advantage |
$390.00
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
BUR 4.0 ROUND 1608-006-137
|
Facility
|
IP
|
$1,147.00
|
|
| Hospital Charge Code |
2966112
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| 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 4.0 ROUND 1608-006-137
|
Facility
|
OP
|
$1,147.00
|
|
| Hospital Charge Code |
2966112
|
|
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 4.5 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 4.5 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: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| 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 4.8 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: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,276.24
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| 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 5.5 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 5.5MM 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: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| 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
|
|
