|
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
|
|
|
BUR 4X48 ROUND CARBIDE
|
Facility
|
OP
|
$1,484.00
|
|
| Hospital Charge Code |
2964898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Aetna Managed Medicare |
$432.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.69
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.52
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: NAPHCARE Commercial |
$926.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$1,003.18
|
| Rate for Payer: Quartz Medicare Advantage |
$926.02
|
| Rate for Payer: The Alliance Commercial |
$771.68
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
BUR 4X48 ROUND CARBIDE
|
Facility
|
IP
|
$1,484.00
|
|
| Hospital Charge Code |
2964898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.25 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$926.02
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
BUR 5.5 CYCLONE H9119
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2964876
|
|
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 5.5 CYCLONE H9119
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2964876
|
|
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 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 |
$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 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 |
$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 5.5 ROUND 1608-006-141
|
Facility
|
OP
|
$1,147.00
|
|
| Hospital Charge Code |
2966114
|
|
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 5.5 ROUND 1608-006-141
|
Facility
|
IP
|
$1,147.00
|
|
| Hospital Charge Code |
2966114
|
|
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 5x38 ROUND CARBIDE LSO
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964899
|
|
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 5x38 ROUND CARBIDE LSO
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964899
|
|
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 6.0MM EGG 1607-002-003
|
Facility
|
OP
|
$1,065.00
|
|
| Hospital Charge Code |
2975078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$1,018.99 |
| Rate for Payer: Aetna Commercial |
$996.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.54
|
| Rate for Payer: Aetna Managed Medicare |
$310.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$719.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$553.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.03
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$1,018.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.83
|
| Rate for Payer: Health EOS Commercial |
$985.76
|
| Rate for Payer: HFN Commercial |
$1,018.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$830.70
|
| Rate for Payer: Multiplan Commercial |
$886.08
|
| Rate for Payer: NAPHCARE Commercial |
$664.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.99
|
| Rate for Payer: Quartz Beloit One Network |
$542.72
|
| Rate for Payer: Quartz Commercial |
$719.94
|
| Rate for Payer: Quartz Medicare Advantage |
$664.56
|
| Rate for Payer: The Alliance Commercial |
$553.80
|
| Rate for Payer: WEA Trust Commercial |
$609.18
|
| Rate for Payer: WPS Commercial |
$820.37
|
|
|
BUR 6.0MM EGG 1607-002-003
|
Facility
|
IP
|
$1,065.00
|
|
| Hospital Charge Code |
2975078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.72 |
| Max. Negotiated Rate |
$1,018.99 |
| Rate for Payer: Aetna Commercial |
$996.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.03
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$1,018.99
|
| Rate for Payer: Health EOS Commercial |
$985.76
|
| Rate for Payer: HFN Commercial |
$1,018.99
|
| Rate for Payer: Multiplan Commercial |
$886.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.99
|
| Rate for Payer: Quartz Beloit One Network |
$542.72
|
| Rate for Payer: Quartz Commercial |
$664.56
|
| Rate for Payer: WEA Trust Commercial |
$609.18
|
| Rate for Payer: WPS Commercial |
$820.37
|
|
|
BUR 6.0 OVAL H9102
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2964877
|
|
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 6.0 OVAL H9102
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2964877
|
|
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 6.3MM ROUND 1608-006-143
|
Facility
|
OP
|
$1,097.00
|
|
| Hospital Charge Code |
2966116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.45 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Aetna Managed Medicare |
$319.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$741.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$570.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$638.45
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.66
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: NAPHCARE Commercial |
$684.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$741.57
|
| Rate for Payer: Quartz Medicare Advantage |
$684.53
|
| Rate for Payer: The Alliance Commercial |
$570.44
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
BUR 6.3MM ROUND 1608-006-143
|
Facility
|
IP
|
$1,097.00
|
|
| Hospital Charge Code |
2966116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.03 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$684.53
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
BUR 6MM DIAMOND E6160
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2969486
|
|
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 6MM DIAMOND E6160
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2969486
|
|
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 8.0 ROUND 1607-002-041
|
Facility
|
OP
|
$1,188.00
|
|
| Hospital Charge Code |
2966117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BUR 8.0 ROUND 1607-002-041
|
Facility
|
IP
|
$1,188.00
|
|
| Hospital Charge Code |
2966117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BUR CARBIDE 0.6 #31-55363
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2965325
|
|
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 CARBIDE 0.6 #31-55363
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2965325
|
|
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 CARBIDE 1.0 #31-55631
|
Facility
|
IP
|
$1,816.00
|
|
| Hospital Charge Code |
2965326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$925.43 |
| Max. Negotiated Rate |
$1,737.55 |
| Rate for Payer: Aetna Commercial |
$1,699.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,000.98
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$1,737.55
|
| Rate for Payer: Health EOS Commercial |
$1,680.89
|
| Rate for Payer: HFN Commercial |
$1,737.55
|
| Rate for Payer: Multiplan Commercial |
$1,510.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.55
|
| Rate for Payer: Quartz Beloit One Network |
$925.43
|
| Rate for Payer: Quartz Commercial |
$1,133.18
|
| Rate for Payer: WEA Trust Commercial |
$1,038.75
|
| Rate for Payer: WPS Commercial |
$1,398.86
|
|
|
BUR CARBIDE 1.0 #31-55631
|
Facility
|
OP
|
$1,816.00
|
|
| Hospital Charge Code |
2965326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.82 |
| Max. Negotiated Rate |
$1,737.55 |
| Rate for Payer: Aetna Commercial |
$1,699.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.23
|
| Rate for Payer: Aetna Managed Medicare |
$528.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,000.98
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$1,737.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,056.91
|
| Rate for Payer: Health EOS Commercial |
$1,680.89
|
| Rate for Payer: HFN Commercial |
$1,737.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.48
|
| Rate for Payer: Multiplan Commercial |
$1,510.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.55
|
| Rate for Payer: Quartz Beloit One Network |
$925.43
|
| Rate for Payer: Quartz Commercial |
$1,227.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.18
|
| Rate for Payer: The Alliance Commercial |
$944.32
|
| Rate for Payer: WEA Trust Commercial |
$1,038.75
|
| Rate for Payer: WPS Commercial |
$1,398.86
|
|
