|
CDS LOWER EXTREMITY BOX DYNJ900883
|
Facility
|
IP
|
$2,402.00
|
|
| Hospital Charge Code |
4124768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,176.98 |
| Max. Negotiated Rate |
$2,209.84 |
| Rate for Payer: Aetna Commercial |
$2,161.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,065.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.06
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,209.84
|
| Rate for Payer: Health EOS Commercial |
$2,137.78
|
| Rate for Payer: HFN Commercial |
$2,209.84
|
| Rate for Payer: Multiplan Commercial |
$1,921.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,441.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.98
|
| Rate for Payer: Quartz Commercial |
$1,441.20
|
| Rate for Payer: WEA Trust Commercial |
$1,321.10
|
| Rate for Payer: WPS Commercial |
$1,779.16
|
|
|
CDS MAJOR PROCEDURE BOX DYNJ900877
|
Facility
|
IP
|
$1,551.00
|
|
| Hospital Charge Code |
4124764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.99 |
| Max. Negotiated Rate |
$1,426.92 |
| Rate for Payer: Aetna Commercial |
$1,395.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,333.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.03
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$1,426.92
|
| Rate for Payer: Health EOS Commercial |
$1,380.39
|
| Rate for Payer: HFN Commercial |
$1,426.92
|
| Rate for Payer: Multiplan Commercial |
$1,240.80
|
| Rate for Payer: NAPHCARE Commercial |
$930.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.92
|
| Rate for Payer: Quartz Beloit One Network |
$759.99
|
| Rate for Payer: Quartz Commercial |
$930.60
|
| Rate for Payer: WEA Trust Commercial |
$853.05
|
| Rate for Payer: WPS Commercial |
$1,148.83
|
|
|
CDS MAJOR PROCEDURE BOX DYNJ900877
|
Facility
|
OP
|
$1,551.00
|
|
| Hospital Charge Code |
4124764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.28 |
| Max. Negotiated Rate |
$6,204.00 |
| Rate for Payer: Aetna Commercial |
$1,395.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,333.86
|
| Rate for Payer: Aetna Managed Medicare |
$434.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$775.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.03
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$1,426.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$867.94
|
| Rate for Payer: Health EOS Commercial |
$1,380.39
|
| Rate for Payer: HFN Commercial |
$1,426.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,163.25
|
| Rate for Payer: Multiplan Commercial |
$1,240.80
|
| Rate for Payer: NAPHCARE Commercial |
$930.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.92
|
| Rate for Payer: Quartz Beloit One Network |
$759.99
|
| Rate for Payer: Quartz Commercial |
$1,008.15
|
| Rate for Payer: Quartz Medicare Advantage |
$930.60
|
| Rate for Payer: The Alliance Commercial |
$6,204.00
|
| Rate for Payer: WEA Trust Commercial |
$853.05
|
| Rate for Payer: WPS Commercial |
$1,148.83
|
|
|
CDS MAJOR VASCULAR BOX DYNJ901191K
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
HCPCS A4550
|
| Hospital Charge Code |
4494486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.84 |
| Max. Negotiated Rate |
$1,302.72 |
| Rate for Payer: Aetna Commercial |
$1,274.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.48
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$1,302.72
|
| Rate for Payer: Health EOS Commercial |
$1,260.24
|
| Rate for Payer: HFN Commercial |
$1,302.72
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: NAPHCARE Commercial |
$849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.72
|
| Rate for Payer: Quartz Beloit One Network |
$693.84
|
| Rate for Payer: Quartz Commercial |
$849.60
|
| Rate for Payer: WEA Trust Commercial |
$778.80
|
| Rate for Payer: WPS Commercial |
$1,048.83
|
|
|
CDS MAJOR VASCULAR BOX DYNJ901191K
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
HCPCS A4550
|
| Hospital Charge Code |
4494486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.48 |
| Max. Negotiated Rate |
$5,664.00 |
| Rate for Payer: Aetna Commercial |
$1,274.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.76
|
| Rate for Payer: Aetna Managed Medicare |
$396.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$920.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$708.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.48
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$1,302.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.39
|
| Rate for Payer: Health EOS Commercial |
$1,260.24
|
| Rate for Payer: HFN Commercial |
$1,302.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,062.00
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: NAPHCARE Commercial |
$849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.72
|
| Rate for Payer: Quartz Beloit One Network |
$693.84
|
| Rate for Payer: Quartz Commercial |
$920.40
|
| Rate for Payer: Quartz Medicare Advantage |
$849.60
|
| Rate for Payer: The Alliance Commercial |
$5,664.00
|
| Rate for Payer: WEA Trust Commercial |
$778.80
|
| Rate for Payer: WPS Commercial |
$1,048.83
|
|
|
CDS MINOR LITHOTOMY BOX DYNJ900888
|
Facility
|
OP
|
$822.00
|
|
| Hospital Charge Code |
4115512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.16 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$739.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Aetna Managed Medicare |
$230.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.66
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$756.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.99
|
| Rate for Payer: Health EOS Commercial |
$731.58
|
| Rate for Payer: HFN Commercial |
$756.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.50
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: NAPHCARE Commercial |
$493.20
|
| Rate for Payer: Preferred Network Access Commercial |
$756.24
|
| Rate for Payer: Quartz Beloit One Network |
$402.78
|
| Rate for Payer: Quartz Commercial |
$534.30
|
| Rate for Payer: Quartz Medicare Advantage |
$493.20
|
| Rate for Payer: The Alliance Commercial |
$3,288.00
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
CDS MINOR LITHOTOMY BOX DYNJ900888
|
Facility
|
IP
|
$822.00
|
|
| Hospital Charge Code |
4115512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.78 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$739.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.66
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$756.24
|
| Rate for Payer: Health EOS Commercial |
$731.58
|
| Rate for Payer: HFN Commercial |
$756.24
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: NAPHCARE Commercial |
$493.20
|
| Rate for Payer: Preferred Network Access Commercial |
$756.24
|
| Rate for Payer: Quartz Beloit One Network |
$402.78
|
| Rate for Payer: Quartz Commercial |
$493.20
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
CDS OPEN HEART ACCESSARY PACK DYNJ47503
|
Facility
|
OP
|
$5,316.00
|
|
| Hospital Charge Code |
4321743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,488.48 |
| Max. Negotiated Rate |
$21,264.00 |
| Rate for Payer: Aetna Commercial |
$4,784.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,571.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,455.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,658.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,817.48
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$4,890.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.83
|
| Rate for Payer: Health EOS Commercial |
$4,731.24
|
| Rate for Payer: HFN Commercial |
$4,890.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,987.00
|
| Rate for Payer: Multiplan Commercial |
$4,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,890.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.84
|
| Rate for Payer: Quartz Commercial |
$3,455.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.60
|
| Rate for Payer: The Alliance Commercial |
$21,264.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.80
|
| Rate for Payer: WPS Commercial |
$3,937.56
|
|
|
CDS OPEN HEART ACCESSARY PACK DYNJ47503
|
Facility
|
IP
|
$5,316.00
|
|
| Hospital Charge Code |
4321743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,604.84 |
| Max. Negotiated Rate |
$4,890.72 |
| Rate for Payer: Aetna Commercial |
$4,784.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,571.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,817.48
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$4,890.72
|
| Rate for Payer: Health EOS Commercial |
$4,731.24
|
| Rate for Payer: HFN Commercial |
$4,890.72
|
| Rate for Payer: Multiplan Commercial |
$4,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,890.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.84
|
| Rate for Payer: Quartz Commercial |
$3,189.60
|
| Rate for Payer: WEA Trust Commercial |
$2,923.80
|
| Rate for Payer: WPS Commercial |
$3,937.56
|
|
|
CDS OPEN HEART PART 1 DYNJ900985
|
Facility
|
OP
|
$5,121.00
|
|
| Hospital Charge Code |
4124777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,433.88 |
| Max. Negotiated Rate |
$20,484.00 |
| Rate for Payer: Aetna Commercial |
$4,608.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,404.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,328.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,458.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,714.13
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,711.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.71
|
| Rate for Payer: Health EOS Commercial |
$4,557.69
|
| Rate for Payer: HFN Commercial |
$4,711.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,840.75
|
| Rate for Payer: Multiplan Commercial |
$4,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,072.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,711.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,509.29
|
| Rate for Payer: Quartz Commercial |
$3,328.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,072.60
|
| Rate for Payer: The Alliance Commercial |
$20,484.00
|
| Rate for Payer: WEA Trust Commercial |
$2,816.55
|
| Rate for Payer: WPS Commercial |
$3,793.12
|
|
|
CDS OPEN HEART PART 1 DYNJ900985
|
Facility
|
IP
|
$5,121.00
|
|
| Hospital Charge Code |
4124777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,509.29 |
| Max. Negotiated Rate |
$4,711.32 |
| Rate for Payer: Aetna Commercial |
$4,608.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,404.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,714.13
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,711.32
|
| Rate for Payer: Health EOS Commercial |
$4,557.69
|
| Rate for Payer: HFN Commercial |
$4,711.32
|
| Rate for Payer: Multiplan Commercial |
$4,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,072.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,711.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,509.29
|
| Rate for Payer: Quartz Commercial |
$3,072.60
|
| Rate for Payer: WEA Trust Commercial |
$2,816.55
|
| Rate for Payer: WPS Commercial |
$3,793.12
|
|
|
CDS OPEN HEART PART 2 DYNJ901075
|
Facility
|
IP
|
$12,959.00
|
|
| Hospital Charge Code |
4318423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,349.91 |
| Max. Negotiated Rate |
$11,922.28 |
| Rate for Payer: Aetna Commercial |
$11,663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,144.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,868.27
|
| Rate for Payer: Cash Price |
$3,887.70
|
| Rate for Payer: Cigna Commercial |
$11,922.28
|
| Rate for Payer: Health EOS Commercial |
$11,533.51
|
| Rate for Payer: HFN Commercial |
$11,922.28
|
| Rate for Payer: Multiplan Commercial |
$10,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,775.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,922.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,349.91
|
| Rate for Payer: Quartz Commercial |
$7,775.40
|
| Rate for Payer: WEA Trust Commercial |
$7,127.45
|
| Rate for Payer: WPS Commercial |
$9,598.73
|
|
|
CDS OPEN HEART PART 2 DYNJ901075
|
Facility
|
OP
|
$12,959.00
|
|
| Hospital Charge Code |
4318423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,628.52 |
| Max. Negotiated Rate |
$51,836.00 |
| Rate for Payer: Aetna Commercial |
$11,663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,144.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,628.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,423.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,220.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,868.27
|
| Rate for Payer: Cash Price |
$3,887.70
|
| Rate for Payer: Cigna Commercial |
$11,922.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,251.86
|
| Rate for Payer: Health EOS Commercial |
$11,533.51
|
| Rate for Payer: HFN Commercial |
$11,922.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,719.25
|
| Rate for Payer: Multiplan Commercial |
$10,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,775.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,922.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,349.91
|
| Rate for Payer: Quartz Commercial |
$8,423.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,775.40
|
| Rate for Payer: The Alliance Commercial |
$51,836.00
|
| Rate for Payer: WEA Trust Commercial |
$7,127.45
|
| Rate for Payer: WPS Commercial |
$9,598.73
|
|
|
CDS PACK ANGIO TRAY DYNJ30565
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2969549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
CDS PACK ANGIO TRAY DYNJ30565
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2969549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$118.20
|
| Rate for Payer: The Alliance Commercial |
$788.00
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
CDS PODIATRY BOX DYNJ900879
|
Facility
|
OP
|
$961.00
|
|
| Hospital Charge Code |
4124775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.08 |
| Max. Negotiated Rate |
$3,844.00 |
| Rate for Payer: Aetna Commercial |
$864.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$826.46
|
| Rate for Payer: Aetna Managed Medicare |
$269.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$624.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$480.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.33
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$884.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.78
|
| Rate for Payer: Health EOS Commercial |
$855.29
|
| Rate for Payer: HFN Commercial |
$884.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$720.75
|
| Rate for Payer: Multiplan Commercial |
$768.80
|
| Rate for Payer: NAPHCARE Commercial |
$576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$884.12
|
| Rate for Payer: Quartz Beloit One Network |
$470.89
|
| Rate for Payer: Quartz Commercial |
$624.65
|
| Rate for Payer: Quartz Medicare Advantage |
$576.60
|
| Rate for Payer: The Alliance Commercial |
$3,844.00
|
| Rate for Payer: WEA Trust Commercial |
$528.55
|
| Rate for Payer: WPS Commercial |
$711.81
|
|
|
CDS PODIATRY BOX DYNJ900879
|
Facility
|
IP
|
$961.00
|
|
| Hospital Charge Code |
4124775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.89 |
| Max. Negotiated Rate |
$884.12 |
| Rate for Payer: Aetna Commercial |
$864.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$826.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.33
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$884.12
|
| Rate for Payer: Health EOS Commercial |
$855.29
|
| Rate for Payer: HFN Commercial |
$884.12
|
| Rate for Payer: Multiplan Commercial |
$768.80
|
| Rate for Payer: NAPHCARE Commercial |
$576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$884.12
|
| Rate for Payer: Quartz Beloit One Network |
$470.89
|
| Rate for Payer: Quartz Commercial |
$576.60
|
| Rate for Payer: WEA Trust Commercial |
$528.55
|
| Rate for Payer: WPS Commercial |
$711.81
|
|
|
CDS SHOULDER BOX DYNJ900889
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
4124773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,252.93 |
| Max. Negotiated Rate |
$2,352.44 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,534.20
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
CDS SHOULDER BOX DYNJ900889
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
4124773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.96 |
| Max. Negotiated Rate |
$10,228.00 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Aetna Managed Medicare |
$715.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,662.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.90
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,662.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,534.20
|
| Rate for Payer: The Alliance Commercial |
$10,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
CDS T & A BOX DYNJ900890
|
Facility
|
IP
|
$2,356.00
|
|
| Hospital Charge Code |
4115513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.44 |
| Max. Negotiated Rate |
$2,167.52 |
| Rate for Payer: Aetna Commercial |
$2,120.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,248.68
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,167.52
|
| Rate for Payer: Health EOS Commercial |
$2,096.84
|
| Rate for Payer: HFN Commercial |
$2,167.52
|
| Rate for Payer: Multiplan Commercial |
$1,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,167.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.44
|
| Rate for Payer: Quartz Commercial |
$1,413.60
|
| Rate for Payer: WEA Trust Commercial |
$1,295.80
|
| Rate for Payer: WPS Commercial |
$1,745.09
|
|
|
CDS T & A BOX DYNJ900890
|
Facility
|
OP
|
$2,356.00
|
|
| Hospital Charge Code |
4115513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.68 |
| Max. Negotiated Rate |
$9,424.00 |
| Rate for Payer: Aetna Commercial |
$2,120.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.16
|
| Rate for Payer: Aetna Managed Medicare |
$659.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,531.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,130.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,248.68
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,167.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,318.42
|
| Rate for Payer: Health EOS Commercial |
$2,096.84
|
| Rate for Payer: HFN Commercial |
$2,167.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,767.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,167.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.44
|
| Rate for Payer: Quartz Commercial |
$1,531.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,413.60
|
| Rate for Payer: The Alliance Commercial |
$9,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,295.80
|
| Rate for Payer: WPS Commercial |
$1,745.09
|
|
|
CDS TOTAL HIP BOX DYNJ900882
|
Facility
|
OP
|
$4,298.00
|
|
| Hospital Charge Code |
4124767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,203.44 |
| Max. Negotiated Rate |
$17,192.00 |
| Rate for Payer: Aetna Commercial |
$3,868.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,696.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,203.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,793.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,063.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.94
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$3,954.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,405.16
|
| Rate for Payer: Health EOS Commercial |
$3,825.22
|
| Rate for Payer: HFN Commercial |
$3,954.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,223.50
|
| Rate for Payer: Multiplan Commercial |
$3,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,578.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,954.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,106.02
|
| Rate for Payer: Quartz Commercial |
$2,793.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,578.80
|
| Rate for Payer: The Alliance Commercial |
$17,192.00
|
| Rate for Payer: WEA Trust Commercial |
$2,363.90
|
| Rate for Payer: WPS Commercial |
$3,183.53
|
|
|
CDS TOTAL HIP BOX DYNJ900882
|
Facility
|
IP
|
$4,298.00
|
|
| Hospital Charge Code |
4124767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,106.02 |
| Max. Negotiated Rate |
$3,954.16 |
| Rate for Payer: Aetna Commercial |
$3,868.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,696.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.94
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$3,954.16
|
| Rate for Payer: Health EOS Commercial |
$3,825.22
|
| Rate for Payer: HFN Commercial |
$3,954.16
|
| Rate for Payer: Multiplan Commercial |
$3,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,578.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,954.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,106.02
|
| Rate for Payer: Quartz Commercial |
$2,578.80
|
| Rate for Payer: WEA Trust Commercial |
$2,363.90
|
| Rate for Payer: WPS Commercial |
$3,183.53
|
|
|
CDS TOTAL KNEE BOX DYNJ900881
|
Facility
|
IP
|
$5,755.00
|
|
| Hospital Charge Code |
4124766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,819.95 |
| Max. Negotiated Rate |
$5,294.60 |
| Rate for Payer: Aetna Commercial |
$5,179.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,949.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,050.15
|
| Rate for Payer: Cash Price |
$1,726.50
|
| Rate for Payer: Cigna Commercial |
$5,294.60
|
| Rate for Payer: Health EOS Commercial |
$5,121.95
|
| Rate for Payer: HFN Commercial |
$5,294.60
|
| Rate for Payer: Multiplan Commercial |
$4,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,294.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.95
|
| Rate for Payer: Quartz Commercial |
$3,453.00
|
| Rate for Payer: WEA Trust Commercial |
$3,165.25
|
| Rate for Payer: WPS Commercial |
$4,262.73
|
|
|
CDS TOTAL KNEE BOX DYNJ900881
|
Facility
|
OP
|
$5,755.00
|
|
| Hospital Charge Code |
4124766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,611.40 |
| Max. Negotiated Rate |
$23,020.00 |
| Rate for Payer: Aetna Commercial |
$5,179.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,949.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,611.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,740.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,877.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,762.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,050.15
|
| Rate for Payer: Cash Price |
$1,726.50
|
| Rate for Payer: Cigna Commercial |
$5,294.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.50
|
| Rate for Payer: Health EOS Commercial |
$5,121.95
|
| Rate for Payer: HFN Commercial |
$5,294.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,316.25
|
| Rate for Payer: Multiplan Commercial |
$4,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,294.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.95
|
| Rate for Payer: Quartz Commercial |
$3,740.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,453.00
|
| Rate for Payer: The Alliance Commercial |
$23,020.00
|
| Rate for Payer: WEA Trust Commercial |
$3,165.25
|
| Rate for Payer: WPS Commercial |
$4,262.73
|
|
