|
CDS MAJOR PROCEDURE BOX DYNJ900877
|
Facility
|
IP
|
$1,551.00
|
|
| Hospital Charge Code |
4124764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.39 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$1,451.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.91
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$1,484.00
|
| Rate for Payer: Health EOS Commercial |
$1,435.61
|
| Rate for Payer: HFN Commercial |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.00
|
| Rate for Payer: Quartz Beloit One Network |
$790.39
|
| Rate for Payer: Quartz Commercial |
$967.82
|
| Rate for Payer: WEA Trust Commercial |
$887.17
|
| Rate for Payer: WPS Commercial |
$1,194.74
|
|
|
CDS MAJOR PROCEDURE BOX DYNJ900877
|
Facility
|
OP
|
$1,551.00
|
|
| Hospital Charge Code |
4124764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.65 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$1,451.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.21
|
| Rate for Payer: Aetna Managed Medicare |
$451.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.91
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$1,484.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.68
|
| Rate for Payer: Health EOS Commercial |
$1,435.61
|
| Rate for Payer: HFN Commercial |
$1,484.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.78
|
| Rate for Payer: Multiplan Commercial |
$1,290.43
|
| Rate for Payer: NAPHCARE Commercial |
$967.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.00
|
| Rate for Payer: Quartz Beloit One Network |
$790.39
|
| Rate for Payer: Quartz Commercial |
$1,048.48
|
| Rate for Payer: Quartz Medicare Advantage |
$967.82
|
| Rate for Payer: The Alliance Commercial |
$806.52
|
| Rate for Payer: WEA Trust Commercial |
$887.17
|
| Rate for Payer: WPS Commercial |
$1,194.74
|
|
|
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 |
$412.34 |
| Max. Negotiated Rate |
$1,354.83 |
| Rate for Payer: Aetna Commercial |
$1,325.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,266.47
|
| Rate for Payer: Aetna Managed Medicare |
$412.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$957.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$736.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.50
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$1,354.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$824.11
|
| Rate for Payer: Health EOS Commercial |
$1,310.65
|
| Rate for Payer: HFN Commercial |
$1,354.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,104.48
|
| Rate for Payer: Multiplan Commercial |
$1,178.11
|
| Rate for Payer: NAPHCARE Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.83
|
| Rate for Payer: Quartz Beloit One Network |
$721.59
|
| Rate for Payer: Quartz Commercial |
$957.22
|
| Rate for Payer: Quartz Medicare Advantage |
$883.58
|
| Rate for Payer: The Alliance Commercial |
$736.32
|
| Rate for Payer: WEA Trust Commercial |
$809.95
|
| Rate for Payer: WPS Commercial |
$1,090.74
|
|
|
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 |
$721.59 |
| Max. Negotiated Rate |
$1,354.83 |
| Rate for Payer: Aetna Commercial |
$1,325.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,266.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.50
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$1,354.83
|
| Rate for Payer: Health EOS Commercial |
$1,310.65
|
| Rate for Payer: HFN Commercial |
$1,354.83
|
| Rate for Payer: Multiplan Commercial |
$1,178.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.83
|
| Rate for Payer: Quartz Beloit One Network |
$721.59
|
| Rate for Payer: Quartz Commercial |
$883.58
|
| Rate for Payer: WEA Trust Commercial |
$809.95
|
| Rate for Payer: WPS Commercial |
$1,090.74
|
|
|
CDS MINOR LITHOTOMY BOX DYNJ900888
|
Facility
|
IP
|
$822.00
|
|
| Hospital Charge Code |
4115512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.89 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$512.93
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
CDS MINOR LITHOTOMY BOX DYNJ900888
|
Facility
|
OP
|
$822.00
|
|
| Hospital Charge Code |
4115512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.37 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$239.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.40
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.16
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$512.93
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$555.67
|
| Rate for Payer: Quartz Medicare Advantage |
$512.93
|
| Rate for Payer: The Alliance Commercial |
$427.44
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
CDS OPEN HEART ACCESSARY PACK DYNJ47503
|
Facility
|
IP
|
$5,316.00
|
|
| Hospital Charge Code |
4321743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,709.03 |
| Max. Negotiated Rate |
$5,086.35 |
| Rate for Payer: Aetna Commercial |
$4,975.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,754.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,930.18
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$5,086.35
|
| Rate for Payer: Health EOS Commercial |
$4,920.49
|
| Rate for Payer: HFN Commercial |
$5,086.35
|
| Rate for Payer: Multiplan Commercial |
$4,422.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,086.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.03
|
| Rate for Payer: Quartz Commercial |
$3,317.18
|
| Rate for Payer: WEA Trust Commercial |
$3,040.75
|
| Rate for Payer: WPS Commercial |
$4,094.91
|
|
|
CDS OPEN HEART ACCESSARY PACK DYNJ47503
|
Facility
|
OP
|
$5,316.00
|
|
| Hospital Charge Code |
4321743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,548.02 |
| Max. Negotiated Rate |
$5,086.35 |
| Rate for Payer: Aetna Commercial |
$4,975.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,754.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,548.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,593.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,764.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,930.18
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$5,086.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.91
|
| Rate for Payer: Health EOS Commercial |
$4,920.49
|
| Rate for Payer: HFN Commercial |
$5,086.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,146.48
|
| Rate for Payer: Multiplan Commercial |
$4,422.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,317.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,086.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.03
|
| Rate for Payer: Quartz Commercial |
$3,593.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,317.18
|
| Rate for Payer: The Alliance Commercial |
$2,764.32
|
| Rate for Payer: WEA Trust Commercial |
$3,040.75
|
| Rate for Payer: WPS Commercial |
$4,094.91
|
|
|
CDS OPEN HEART PART 1 DYNJ900985
|
Facility
|
IP
|
$5,121.00
|
|
| Hospital Charge Code |
4124777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,609.66 |
| Max. Negotiated Rate |
$4,899.77 |
| Rate for Payer: Aetna Commercial |
$4,793.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.70
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,899.77
|
| Rate for Payer: Health EOS Commercial |
$4,740.00
|
| Rate for Payer: HFN Commercial |
$4,899.77
|
| Rate for Payer: Multiplan Commercial |
$4,260.67
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.66
|
| Rate for Payer: Quartz Commercial |
$3,195.50
|
| Rate for Payer: WEA Trust Commercial |
$2,929.21
|
| Rate for Payer: WPS Commercial |
$3,944.71
|
|
|
CDS OPEN HEART PART 1 DYNJ900985
|
Facility
|
OP
|
$5,121.00
|
|
| Hospital Charge Code |
4124777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.24 |
| Max. Negotiated Rate |
$4,899.77 |
| Rate for Payer: Aetna Commercial |
$4,793.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,491.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,461.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,662.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,556.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.70
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,899.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,980.42
|
| Rate for Payer: Health EOS Commercial |
$4,740.00
|
| Rate for Payer: HFN Commercial |
$4,899.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,994.38
|
| Rate for Payer: Multiplan Commercial |
$4,260.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.66
|
| Rate for Payer: Quartz Commercial |
$3,461.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,195.50
|
| Rate for Payer: The Alliance Commercial |
$2,662.92
|
| Rate for Payer: WEA Trust Commercial |
$2,929.21
|
| Rate for Payer: WPS Commercial |
$3,944.71
|
|
|
CDS OPEN HEART PART 2 DYNJ901075
|
Facility
|
OP
|
$12,959.00
|
|
| Hospital Charge Code |
4318423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,773.66 |
| Max. Negotiated Rate |
$12,399.17 |
| Rate for Payer: Aetna Commercial |
$12,129.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,590.53
|
| Rate for Payer: Aetna Managed Medicare |
$3,773.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,760.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,738.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,469.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,143.00
|
| Rate for Payer: Cash Price |
$3,887.70
|
| Rate for Payer: Cigna Commercial |
$12,399.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,542.14
|
| Rate for Payer: Health EOS Commercial |
$11,994.85
|
| Rate for Payer: HFN Commercial |
$12,399.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,108.02
|
| Rate for Payer: Multiplan Commercial |
$10,781.89
|
| Rate for Payer: NAPHCARE Commercial |
$8,086.42
|
| Rate for Payer: Preferred Network Access Commercial |
$12,399.17
|
| Rate for Payer: Quartz Beloit One Network |
$6,603.91
|
| Rate for Payer: Quartz Commercial |
$8,760.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,086.42
|
| Rate for Payer: The Alliance Commercial |
$6,738.68
|
| Rate for Payer: WEA Trust Commercial |
$7,412.55
|
| Rate for Payer: WPS Commercial |
$9,982.32
|
|
|
CDS OPEN HEART PART 2 DYNJ901075
|
Facility
|
IP
|
$12,959.00
|
|
| Hospital Charge Code |
4318423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,603.91 |
| Max. Negotiated Rate |
$12,399.17 |
| Rate for Payer: Aetna Commercial |
$12,129.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,590.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,143.00
|
| Rate for Payer: Cash Price |
$3,887.70
|
| Rate for Payer: Cigna Commercial |
$12,399.17
|
| Rate for Payer: Health EOS Commercial |
$11,994.85
|
| Rate for Payer: HFN Commercial |
$12,399.17
|
| Rate for Payer: Multiplan Commercial |
$10,781.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,399.17
|
| Rate for Payer: Quartz Beloit One Network |
$6,603.91
|
| Rate for Payer: Quartz Commercial |
$8,086.42
|
| Rate for Payer: WEA Trust Commercial |
$7,412.55
|
| Rate for Payer: WPS Commercial |
$9,982.32
|
|
|
CDS PACK ANGIO TRAY DYNJ30565
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2969549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$57.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.66
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$122.93
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$122.93
|
| Rate for Payer: The Alliance Commercial |
$102.44
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
CDS PACK ANGIO TRAY DYNJ30565
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2969549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
CDS PODIATRY BOX DYNJ900879
|
Facility
|
OP
|
$961.00
|
|
| Hospital Charge Code |
4124775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.84 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.52
|
| Rate for Payer: Aetna Managed Medicare |
$279.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$499.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$479.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.70
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$919.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.30
|
| Rate for Payer: Health EOS Commercial |
$889.50
|
| Rate for Payer: HFN Commercial |
$919.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$749.58
|
| Rate for Payer: Multiplan Commercial |
$799.55
|
| Rate for Payer: NAPHCARE Commercial |
$599.66
|
| Rate for Payer: Preferred Network Access Commercial |
$919.48
|
| Rate for Payer: Quartz Beloit One Network |
$489.73
|
| Rate for Payer: Quartz Commercial |
$649.64
|
| Rate for Payer: Quartz Medicare Advantage |
$599.66
|
| Rate for Payer: The Alliance Commercial |
$499.72
|
| Rate for Payer: WEA Trust Commercial |
$549.69
|
| Rate for Payer: WPS Commercial |
$740.26
|
|
|
CDS PODIATRY BOX DYNJ900879
|
Facility
|
IP
|
$961.00
|
|
| Hospital Charge Code |
4124775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.73 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.70
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$919.48
|
| Rate for Payer: Health EOS Commercial |
$889.50
|
| Rate for Payer: HFN Commercial |
$919.48
|
| Rate for Payer: Multiplan Commercial |
$799.55
|
| Rate for Payer: Preferred Network Access Commercial |
$919.48
|
| Rate for Payer: Quartz Beloit One Network |
$489.73
|
| Rate for Payer: Quartz Commercial |
$599.66
|
| Rate for Payer: WEA Trust Commercial |
$549.69
|
| Rate for Payer: WPS Commercial |
$740.26
|
|
|
CDS SHOULDER BOX DYNJ900889
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
4124773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Aetna Managed Medicare |
$744.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.17
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.46
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,728.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.57
|
| Rate for Payer: The Alliance Commercial |
$1,329.64
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
CDS SHOULDER BOX DYNJ900889
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
4124773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.05 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,595.57
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
CDS T & A BOX DYNJ900890
|
Facility
|
IP
|
$2,356.00
|
|
| Hospital Charge Code |
4115513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.62 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,470.14
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
CDS T & A BOX DYNJ900890
|
Facility
|
OP
|
$2,356.00
|
|
| Hospital Charge Code |
4115513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.07 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Aetna Managed Medicare |
$686.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,592.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,225.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,176.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.19
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,837.68
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,592.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,470.14
|
| Rate for Payer: The Alliance Commercial |
$1,225.12
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
CDS TOTAL HIP BOX DYNJ900882
|
Facility
|
IP
|
$4,298.00
|
|
| Hospital Charge Code |
4124767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,190.26 |
| Max. Negotiated Rate |
$4,112.33 |
| Rate for Payer: Aetna Commercial |
$4,022.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,844.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.06
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$4,112.33
|
| Rate for Payer: Health EOS Commercial |
$3,978.23
|
| Rate for Payer: HFN Commercial |
$4,112.33
|
| Rate for Payer: Multiplan Commercial |
$3,575.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,112.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.26
|
| Rate for Payer: Quartz Commercial |
$2,681.95
|
| Rate for Payer: WEA Trust Commercial |
$2,458.46
|
| Rate for Payer: WPS Commercial |
$3,310.75
|
|
|
CDS TOTAL HIP BOX DYNJ900882
|
Facility
|
OP
|
$4,298.00
|
|
| Hospital Charge Code |
4124767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.58 |
| Max. Negotiated Rate |
$4,112.33 |
| Rate for Payer: Aetna Commercial |
$4,022.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,844.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,905.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,234.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,145.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.06
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$4,112.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,501.44
|
| Rate for Payer: Health EOS Commercial |
$3,978.23
|
| Rate for Payer: HFN Commercial |
$4,112.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,352.44
|
| Rate for Payer: Multiplan Commercial |
$3,575.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,681.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,112.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.26
|
| Rate for Payer: Quartz Commercial |
$2,905.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,681.95
|
| Rate for Payer: The Alliance Commercial |
$2,234.96
|
| Rate for Payer: WEA Trust Commercial |
$2,458.46
|
| Rate for Payer: WPS Commercial |
$3,310.75
|
|
|
CDS TOTAL KNEE BOX DYNJ900881
|
Facility
|
OP
|
$5,755.00
|
|
| Hospital Charge Code |
4124766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,675.86 |
| Max. Negotiated Rate |
$5,506.38 |
| Rate for Payer: Aetna Commercial |
$5,386.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,147.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,890.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,992.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,872.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,172.16
|
| Rate for Payer: Cash Price |
$1,726.50
|
| Rate for Payer: Cigna Commercial |
$5,506.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,349.41
|
| Rate for Payer: Health EOS Commercial |
$5,326.83
|
| Rate for Payer: HFN Commercial |
$5,506.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,488.90
|
| Rate for Payer: Multiplan Commercial |
$4,788.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,591.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,506.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.75
|
| Rate for Payer: Quartz Commercial |
$3,890.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,591.12
|
| Rate for Payer: The Alliance Commercial |
$2,992.60
|
| Rate for Payer: WEA Trust Commercial |
$3,291.86
|
| Rate for Payer: WPS Commercial |
$4,433.08
|
|
|
CDS TOTAL KNEE BOX DYNJ900881
|
Facility
|
IP
|
$5,755.00
|
|
| Hospital Charge Code |
4124766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,932.75 |
| Max. Negotiated Rate |
$5,506.38 |
| Rate for Payer: Aetna Commercial |
$5,386.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,147.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,172.16
|
| Rate for Payer: Cash Price |
$1,726.50
|
| Rate for Payer: Cigna Commercial |
$5,506.38
|
| Rate for Payer: Health EOS Commercial |
$5,326.83
|
| Rate for Payer: HFN Commercial |
$5,506.38
|
| Rate for Payer: Multiplan Commercial |
$4,788.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,506.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.75
|
| Rate for Payer: Quartz Commercial |
$3,591.12
|
| Rate for Payer: WEA Trust Commercial |
$3,291.86
|
| Rate for Payer: WPS Commercial |
$4,433.08
|
|
|
CDS UPPER EXTREMITY BOX DYNJ900880
|
Facility
|
OP
|
$1,904.00
|
|
| Hospital Charge Code |
4124776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
