|
BUR 3.0MM ROUND SMALL JOINT ARTHREX AR-9300RBT
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5348979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.36 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$269.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.35
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.50
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$577.20
|
| Rate for Payer: The Alliance Commercial |
$481.00
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
BUR 3.0MM ROUND SMALL JOINT ARTHREX AR-9300RBT
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5348979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
BUR 3.0 NEURO MIS CURVED
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2966110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
BUR 3.0 NEURO MIS CURVED
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2966110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.62
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$1,189.76
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
BUR 3.5 SMALL JOINT C9912
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
3072545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
BUR 3.5 SMALL JOINT C9912
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
3072545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
BUR 3x38 ROUND CARBIDE LSO
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.38 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$999.65
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
BUR 3x38 ROUND CARBIDE LSO
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.50 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Aetna Managed Medicare |
$466.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,082.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$833.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$799.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.36
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.56
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: NAPHCARE Commercial |
$999.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$1,082.95
|
| Rate for Payer: Quartz Medicare Advantage |
$999.65
|
| Rate for Payer: The Alliance Commercial |
$833.04
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
BUR 3X48 DIAMOND ROUND E5230
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2969485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
BUR 3X48 DIAMOND ROUND E5230
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2969485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
BUR 3x48 ROUND DIAMOND CRS
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2969469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
BUR 3x48 ROUND DIAMOND CRS
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2969469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
BUR 4.0MM EGG 1607-002-035
|
Facility
|
OP
|
$1,107.00
|
|
| Hospital Charge Code |
2966111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.36 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$322.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$575.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.27
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$863.46
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$690.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$748.33
|
| Rate for Payer: Quartz Medicare Advantage |
$690.77
|
| Rate for Payer: The Alliance Commercial |
$575.64
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
BUR 4.0MM EGG 1607-002-035
|
Facility
|
IP
|
$1,107.00
|
|
| Hospital Charge Code |
2966111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.13 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$690.77
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
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 |
$391.66 |
| Max. Negotiated Rate |
$1,286.90 |
| Rate for Payer: Aetna Commercial |
$1,258.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.97
|
| Rate for Payer: Aetna Managed Medicare |
$391.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.36
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cigna Commercial |
$1,286.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$782.79
|
| Rate for Payer: Health EOS Commercial |
$1,244.93
|
| Rate for Payer: HFN Commercial |
$1,286.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.10
|
| Rate for Payer: Multiplan Commercial |
$1,119.04
|
| Rate for Payer: NAPHCARE Commercial |
$839.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.90
|
| Rate for Payer: Quartz Beloit One Network |
$685.41
|
| Rate for Payer: Quartz Commercial |
$909.22
|
| Rate for Payer: Quartz Medicare Advantage |
$839.28
|
| Rate for Payer: The Alliance Commercial |
$699.40
|
| Rate for Payer: WEA Trust Commercial |
$769.34
|
| Rate for Payer: WPS Commercial |
$1,036.05
|
|
|
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 |
$685.41 |
| Max. Negotiated Rate |
$1,286.90 |
| Rate for Payer: Aetna Commercial |
$1,258.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.36
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cigna Commercial |
$1,286.90
|
| Rate for Payer: Health EOS Commercial |
$1,244.93
|
| Rate for Payer: HFN Commercial |
$1,286.90
|
| Rate for Payer: Multiplan Commercial |
$1,119.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.90
|
| Rate for Payer: Quartz Beloit One Network |
$685.41
|
| Rate for Payer: Quartz Commercial |
$839.28
|
| Rate for Payer: WEA Trust Commercial |
$769.34
|
| Rate for Payer: WPS Commercial |
$1,036.05
|
|
|
BUR 4.0 OVAL H9101
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
BUR 4.0 OVAL H9101
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
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 |
$189.28 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Aetna Managed Medicare |
$189.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$439.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.30
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: NAPHCARE Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$439.40
|
| Rate for Payer: Quartz Medicare Advantage |
$405.60
|
| Rate for Payer: The Alliance Commercial |
$338.00
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.69
|
|
|
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 |
$331.24 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.69
|
|
|
BUR 4.0 ROUND 1608-006-137
|
Facility
|
OP
|
$1,147.00
|
|
| Hospital Charge Code |
2966112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.01 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$1,073.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.88
|
| Rate for Payer: Aetna Managed Medicare |
$334.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$775.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$572.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.23
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,097.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.55
|
| Rate for Payer: Health EOS Commercial |
$1,061.66
|
| Rate for Payer: HFN Commercial |
$1,097.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$894.66
|
| Rate for Payer: Multiplan Commercial |
$954.30
|
| Rate for Payer: NAPHCARE Commercial |
$715.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.45
|
| Rate for Payer: Quartz Beloit One Network |
$584.51
|
| Rate for Payer: Quartz Commercial |
$775.37
|
| Rate for Payer: Quartz Medicare Advantage |
$715.73
|
| Rate for Payer: The Alliance Commercial |
$596.44
|
| Rate for Payer: WEA Trust Commercial |
$656.08
|
| Rate for Payer: WPS Commercial |
$883.53
|
|
|
BUR 4.0 ROUND 1608-006-137
|
Facility
|
IP
|
$1,147.00
|
|
| Hospital Charge Code |
2966112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.51 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$1,073.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.23
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,097.45
|
| Rate for Payer: Health EOS Commercial |
$1,061.66
|
| Rate for Payer: HFN Commercial |
$1,097.45
|
| Rate for Payer: Multiplan Commercial |
$954.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.45
|
| Rate for Payer: Quartz Beloit One Network |
$584.51
|
| Rate for Payer: Quartz Commercial |
$715.73
|
| Rate for Payer: WEA Trust Commercial |
$656.08
|
| Rate for Payer: WPS Commercial |
$883.53
|
|
|
BUR 4.5 ROUND H9111
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2964875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
BUR 4.5 ROUND H9111
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2964875
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
BUR 4.8 ROUND 1608-006-139
|
Facility
|
IP
|
$1,147.00
|
|
| Hospital Charge Code |
2966113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.51 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$1,073.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.23
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,097.45
|
| Rate for Payer: Health EOS Commercial |
$1,061.66
|
| Rate for Payer: HFN Commercial |
$1,097.45
|
| Rate for Payer: Multiplan Commercial |
$954.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.45
|
| Rate for Payer: Quartz Beloit One Network |
$584.51
|
| Rate for Payer: Quartz Commercial |
$715.73
|
| Rate for Payer: WEA Trust Commercial |
$656.08
|
| Rate for Payer: WPS Commercial |
$883.53
|
|
