|
CAST SCOTCHCAST 3 WHITE
|
Facility
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963668
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
CAST SCOTCHCAST 3 WHITE
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963668
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
CAST SCOTCHCAST 4 WHITE
|
Facility
IP
|
$123.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963608
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
CAST SCOTCHCAST 4 WHITE
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963608
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
CAST SPECIALIST 2 X-FAST
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS A4580
|
| Hospital Charge Code |
2963948
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Aetna Managed Medicare |
$9.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.03
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$22.10
|
| Rate for Payer: Quartz Medicare Advantage |
$20.40
|
| Rate for Payer: The Alliance Commercial |
$136.00
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
CAST SPECIALIST 2 X-FAST
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
HCPCS A4580
|
| Hospital Charge Code |
2963948
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$20.40
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
CAST SPECIALIST 6 X 5YRDS
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
HCPCS A4580
|
| Hospital Charge Code |
2963735
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$72.00
|
| Rate for Payer: The Alliance Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
CAST SPECIALIST 6 X 5YRDS
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
HCPCS A4580
|
| Hospital Charge Code |
2963735
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
CAST/SPLINT ABOVE KNEE
|
Facility
OP
|
$1,731.00
|
|
| Hospital Charge Code |
3075858
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$484.68 |
| Max. Negotiated Rate |
$6,924.00 |
| Rate for Payer: Aetna Commercial |
$1,557.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.66
|
| Rate for Payer: Aetna Managed Medicare |
$484.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,125.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$865.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$830.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.43
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,592.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$968.67
|
| Rate for Payer: Health EOS Commercial |
$1,540.59
|
| Rate for Payer: HFN Commercial |
$1,592.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,298.25
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.52
|
| Rate for Payer: Quartz Beloit One Network |
$848.19
|
| Rate for Payer: Quartz Commercial |
$1,125.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,038.60
|
| Rate for Payer: The Alliance Commercial |
$6,924.00
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,282.15
|
|
|
CAST/SPLINT ABOVE KNEE
|
Facility
IP
|
$1,731.00
|
|
| Hospital Charge Code |
3075858
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$848.19 |
| Max. Negotiated Rate |
$1,592.52 |
| Rate for Payer: Aetna Commercial |
$1,557.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.43
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,592.52
|
| Rate for Payer: Health EOS Commercial |
$1,540.59
|
| Rate for Payer: HFN Commercial |
$1,592.52
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.52
|
| Rate for Payer: Quartz Beloit One Network |
$848.19
|
| Rate for Payer: Quartz Commercial |
$1,038.60
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,282.15
|
|
|
CAST/SPLINT BELOW KNEE
|
Facility
IP
|
$1,323.00
|
|
| Hospital Charge Code |
3075859
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$648.27 |
| Max. Negotiated Rate |
$1,217.16 |
| Rate for Payer: Aetna Commercial |
$1,190.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$701.19
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna Commercial |
$1,217.16
|
| Rate for Payer: Health EOS Commercial |
$1,177.47
|
| Rate for Payer: HFN Commercial |
$1,217.16
|
| Rate for Payer: Multiplan Commercial |
$1,058.40
|
| Rate for Payer: NAPHCARE Commercial |
$793.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,217.16
|
| Rate for Payer: Quartz Beloit One Network |
$648.27
|
| Rate for Payer: Quartz Commercial |
$793.80
|
| Rate for Payer: WEA Trust Commercial |
$727.65
|
| Rate for Payer: WPS Commercial |
$979.95
|
|
|
CAST/SPLINT BELOW KNEE
|
Facility
OP
|
$1,323.00
|
|
| Hospital Charge Code |
3075859
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$370.44 |
| Max. Negotiated Rate |
$5,292.00 |
| Rate for Payer: Aetna Commercial |
$1,190.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,137.78
|
| Rate for Payer: Aetna Managed Medicare |
$370.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$701.19
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna Commercial |
$1,217.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.35
|
| Rate for Payer: Health EOS Commercial |
$1,177.47
|
| Rate for Payer: HFN Commercial |
$1,217.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$992.25
|
| Rate for Payer: Multiplan Commercial |
$1,058.40
|
| Rate for Payer: NAPHCARE Commercial |
$793.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,217.16
|
| Rate for Payer: Quartz Beloit One Network |
$648.27
|
| Rate for Payer: Quartz Commercial |
$859.95
|
| Rate for Payer: Quartz Medicare Advantage |
$793.80
|
| Rate for Payer: The Alliance Commercial |
$5,292.00
|
| Rate for Payer: WEA Trust Commercial |
$727.65
|
| Rate for Payer: WPS Commercial |
$979.95
|
|
|
CAST/SPLINT LONG ARM
|
Facility
IP
|
$1,445.00
|
|
| Hospital Charge Code |
3075856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$765.85
|
| Rate for Payer: Cash Price |
$433.50
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: Health EOS Commercial |
$1,286.05
|
| Rate for Payer: HFN Commercial |
$1,329.40
|
| Rate for Payer: Multiplan Commercial |
$1,156.00
|
| Rate for Payer: NAPHCARE Commercial |
$867.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,329.40
|
| Rate for Payer: Quartz Beloit One Network |
$708.05
|
| Rate for Payer: Quartz Commercial |
$867.00
|
| Rate for Payer: WEA Trust Commercial |
$794.75
|
| Rate for Payer: WPS Commercial |
$1,070.31
|
|
|
CAST/SPLINT LONG ARM
|
Facility
OP
|
$1,445.00
|
|
| Hospital Charge Code |
3075856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$5,780.00 |
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,242.70
|
| Rate for Payer: Aetna Managed Medicare |
$404.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$939.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$722.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$693.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$765.85
|
| Rate for Payer: Cash Price |
$433.50
|
| Rate for Payer: Cigna Commercial |
$1,329.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$808.62
|
| Rate for Payer: Health EOS Commercial |
$1,286.05
|
| Rate for Payer: HFN Commercial |
$1,329.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,083.75
|
| Rate for Payer: Multiplan Commercial |
$1,156.00
|
| Rate for Payer: NAPHCARE Commercial |
$867.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,329.40
|
| Rate for Payer: Quartz Beloit One Network |
$708.05
|
| Rate for Payer: Quartz Commercial |
$939.25
|
| Rate for Payer: Quartz Medicare Advantage |
$867.00
|
| Rate for Payer: The Alliance Commercial |
$5,780.00
|
| Rate for Payer: WEA Trust Commercial |
$794.75
|
| Rate for Payer: WPS Commercial |
$1,070.31
|
|
|
CAST/SPLINT SHORT ARM
|
Facility
IP
|
$1,208.00
|
|
| Hospital Charge Code |
3075857
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$591.92 |
| Max. Negotiated Rate |
$1,111.36 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.24
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,111.36
|
| Rate for Payer: Health EOS Commercial |
$1,075.12
|
| Rate for Payer: HFN Commercial |
$1,111.36
|
| Rate for Payer: Multiplan Commercial |
$966.40
|
| Rate for Payer: NAPHCARE Commercial |
$724.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.36
|
| Rate for Payer: Quartz Beloit One Network |
$591.92
|
| Rate for Payer: Quartz Commercial |
$724.80
|
| Rate for Payer: WEA Trust Commercial |
$664.40
|
| Rate for Payer: WPS Commercial |
$894.77
|
|
|
CAST/SPLINT SHORT ARM
|
Facility
OP
|
$1,208.00
|
|
| Hospital Charge Code |
3075857
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$4,832.00 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.88
|
| Rate for Payer: Aetna Managed Medicare |
$338.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$785.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$604.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.24
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,111.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$676.00
|
| Rate for Payer: Health EOS Commercial |
$1,075.12
|
| Rate for Payer: HFN Commercial |
$1,111.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$906.00
|
| Rate for Payer: Multiplan Commercial |
$966.40
|
| Rate for Payer: NAPHCARE Commercial |
$724.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.36
|
| Rate for Payer: Quartz Beloit One Network |
$591.92
|
| Rate for Payer: Quartz Commercial |
$785.20
|
| Rate for Payer: Quartz Medicare Advantage |
$724.80
|
| Rate for Payer: The Alliance Commercial |
$4,832.00
|
| Rate for Payer: WEA Trust Commercial |
$664.40
|
| Rate for Payer: WPS Commercial |
$894.77
|
|
|
Cast Sup Long Arm Adult Fbrgl Q4006
|
Professional
|
$82.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
3133632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.20
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.02
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: The Alliance Commercial |
$41.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Cast Sup Long Arm Adult Fbrgl Q4006
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
3133632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Cast Sup Long Arm Adult Fbrgl Q4006
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
3133632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$607.64 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$607.64
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Cast Sup Long Arm Ped Fbrgl Q4008
|
Professional
|
$37.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
3219507
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$54.01 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.20
|
| Rate for Payer: Health EOS Commercial |
$33.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.01
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Preferred Network Access Commercial |
$35.15
|
| Rate for Payer: Quartz Beloit One Network |
$16.28
|
| Rate for Payer: Quartz Commercial |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$18.50
|
| Rate for Payer: United Healthcare Medicaid |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Cast Sup Long Arm Ped Fbrgl Q4008
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
3219507
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$34.04 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.20
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$22.20
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Cast Sup Long Arm Ped Fbrgl Q4008
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
3219507
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$339.72 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Aetna Managed Medicare |
$10.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.71
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.20
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$24.05
|
| Rate for Payer: Quartz Medicare Advantage |
$22.20
|
| Rate for Payer: The Alliance Commercial |
$339.72
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Cast Sup Long Arm Splint Fbrg Q4018
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Hospital Charge Code |
3133627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Cast Sup Long Arm Splint Fbrg Q4018
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Hospital Charge Code |
3133627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$3,051.52 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$3,051.52
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Cast Sup Long Arm Splint Fbrg Q4018
|
Professional
|
$73.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Hospital Charge Code |
3133627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.80
|
| Rate for Payer: Health EOS Commercial |
$66.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.69
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Preferred Network Access Commercial |
$69.35
|
| Rate for Payer: Quartz Beloit One Network |
$32.12
|
| Rate for Payer: Quartz Commercial |
$41.61
|
| Rate for Payer: The Alliance Commercial |
$36.50
|
| Rate for Payer: United Healthcare Medicaid |
$10.53
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
