|
Foot Insert Long/Met Support L3020
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS L3020
|
| Hospital Charge Code |
5571973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$1,014.33 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$1,014.33
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
FOOT OSTEOTOMY
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
FOOT OSTEOTOMY
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
Foot Plas Heel Stabi Pre Ots L3170
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS L3170
|
| Hospital Charge Code |
4598613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$187.45 |
| Rate for Payer: Aetna Commercial |
$137.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$65.02
|
| Rate for Payer: Anthem Medicare Advantage |
$65.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$137.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.02
|
| Rate for Payer: Health EOS Commercial |
$131.55
|
| Rate for Payer: HFN Commercial |
$137.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$97.53
|
| Rate for Payer: Preferred Network Access Commercial |
$137.33
|
| Rate for Payer: Quartz Beloit One Network |
$63.61
|
| Rate for Payer: Quartz Commercial |
$82.40
|
| Rate for Payer: Quartz Medicare Advantage |
$65.02
|
| Rate for Payer: The Alliance Commercial |
$178.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.02
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$113.79
|
|
|
Foot Plas Heel Stabi Pre Ots L3170
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS L3170
|
| Hospital Charge Code |
4598613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Foot Plas Heel Stabi Pre Ots L3170
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS L3170
|
| Hospital Charge Code |
4598613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$260.08 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$40.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.42
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$86.74
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$86.74
|
| Rate for Payer: The Alliance Commercial |
$260.08
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$48,086.48
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$14,821.49 |
| Max. Negotiated Rate |
$48,086.48 |
| Rate for Payer: Aetna Managed Medicare |
$14,821.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,784.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,260.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,699.94
|
| Rate for Payer: Anthem Medicare Advantage |
$14,821.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,821.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,821.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,821.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,969.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,821.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,025.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,821.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,821.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,821.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,821.49
|
| Rate for Payer: NAPHCARE Commercial |
$22,232.23
|
| Rate for Payer: Quartz Medicare Advantage |
$14,821.49
|
| Rate for Payer: The Alliance Commercial |
$48,086.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,821.49
|
| Rate for Payer: United Healthcare PPO |
$27,267.87
|
| Rate for Payer: Wellcare Medicare |
$14,821.49
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$74,485.84
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$21,881.56 |
| Max. Negotiated Rate |
$74,485.84 |
| Rate for Payer: Aetna Managed Medicare |
$21,881.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60,899.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,679.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44,348.12
|
| Rate for Payer: Anthem Medicare Advantage |
$21,881.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,881.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,881.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,881.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49,230.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,881.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54,388.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,881.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,881.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,881.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,881.56
|
| Rate for Payer: NAPHCARE Commercial |
$32,822.34
|
| Rate for Payer: Quartz Medicare Advantage |
$21,881.56
|
| Rate for Payer: The Alliance Commercial |
$74,485.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,881.56
|
| Rate for Payer: United Healthcare PPO |
$42,342.48
|
| Rate for Payer: Wellcare Medicare |
$21,881.56
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,494.72
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$14,236.40 |
| Max. Negotiated Rate |
$47,494.72 |
| Rate for Payer: Aetna Managed Medicare |
$14,236.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,117.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,983.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,486.01
|
| Rate for Payer: Anthem Medicare Advantage |
$14,236.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,236.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,236.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,236.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,622.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,236.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,591.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,236.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,236.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,236.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,236.40
|
| Rate for Payer: NAPHCARE Commercial |
$21,354.61
|
| Rate for Payer: Quartz Medicare Advantage |
$14,236.40
|
| Rate for Payer: The Alliance Commercial |
$47,494.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,236.40
|
| Rate for Payer: United Healthcare PPO |
$26,930.00
|
| Rate for Payer: Wellcare Medicare |
$14,236.40
|
|
|
FOOT RING LONG 140MM 4934-2-140
|
Facility
|
OP
|
$6,946.00
|
|
| Hospital Charge Code |
6001641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,022.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,695.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,611.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,467.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$3,611.92
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
FOOT RING LONG 140MM 4934-2-140
|
Facility
|
IP
|
$6,946.00
|
|
| Hospital Charge Code |
6001641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
FOOT RING LONG 155MM 4934-2-155
|
Facility
|
OP
|
$6,946.00
|
|
| Hospital Charge Code |
5611675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,022.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,695.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,611.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,467.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$3,611.92
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
FOOT RING LONG 155MM 4934-2-155
|
Facility
|
IP
|
$6,946.00
|
|
| Hospital Charge Code |
5611675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
FOOT RING LONG 180MM 4934-2-180
|
Facility
|
IP
|
$7,511.00
|
|
| Hospital Charge Code |
5603593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,827.61 |
| Max. Negotiated Rate |
$7,186.52 |
| Rate for Payer: Aetna Commercial |
$7,030.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,717.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,140.06
|
| Rate for Payer: Cash Price |
$2,253.30
|
| Rate for Payer: Cigna Commercial |
$7,186.52
|
| Rate for Payer: Health EOS Commercial |
$6,952.18
|
| Rate for Payer: HFN Commercial |
$7,186.52
|
| Rate for Payer: Multiplan Commercial |
$6,249.15
|
| Rate for Payer: Preferred Network Access Commercial |
$7,186.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,827.61
|
| Rate for Payer: Quartz Commercial |
$4,686.86
|
| Rate for Payer: WEA Trust Commercial |
$4,296.29
|
| Rate for Payer: WPS Commercial |
$5,785.72
|
|
|
FOOT RING LONG 180MM 4934-2-180
|
Facility
|
OP
|
$7,511.00
|
|
| Hospital Charge Code |
5603593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$7,186.52 |
| Rate for Payer: Aetna Commercial |
$7,030.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,717.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,187.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,077.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,905.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,749.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,140.06
|
| Rate for Payer: Cash Price |
$2,253.30
|
| Rate for Payer: Cigna Commercial |
$7,186.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,371.40
|
| Rate for Payer: Health EOS Commercial |
$6,952.18
|
| Rate for Payer: HFN Commercial |
$7,186.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,858.58
|
| Rate for Payer: Multiplan Commercial |
$6,249.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,686.86
|
| Rate for Payer: Preferred Network Access Commercial |
$7,186.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,827.61
|
| Rate for Payer: Quartz Commercial |
$5,077.44
|
| Rate for Payer: Quartz Medicare Advantage |
$4,686.86
|
| Rate for Payer: The Alliance Commercial |
$3,905.72
|
| Rate for Payer: WEA Trust Commercial |
$4,296.29
|
| Rate for Payer: WPS Commercial |
$5,785.72
|
|
|
FOOT RING SHORT 155MM 4934-3-155
|
Facility
|
IP
|
$7,179.00
|
|
| Hospital Charge Code |
6065670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,658.42 |
| Max. Negotiated Rate |
$6,868.87 |
| Rate for Payer: Aetna Commercial |
$6,719.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,420.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,957.06
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cigna Commercial |
$6,868.87
|
| Rate for Payer: Health EOS Commercial |
$6,644.88
|
| Rate for Payer: HFN Commercial |
$6,868.87
|
| Rate for Payer: Multiplan Commercial |
$5,972.93
|
| Rate for Payer: Preferred Network Access Commercial |
$6,868.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,658.42
|
| Rate for Payer: Quartz Commercial |
$4,479.70
|
| Rate for Payer: WEA Trust Commercial |
$4,106.39
|
| Rate for Payer: WPS Commercial |
$5,529.98
|
|
|
FOOT RING SHORT 155MM 4934-3-155
|
Facility
|
OP
|
$7,179.00
|
|
| Hospital Charge Code |
6065670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,090.52 |
| Max. Negotiated Rate |
$6,868.87 |
| Rate for Payer: Aetna Commercial |
$6,719.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,420.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,090.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,853.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,733.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,583.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,957.06
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cigna Commercial |
$6,868.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,178.18
|
| Rate for Payer: Health EOS Commercial |
$6,644.88
|
| Rate for Payer: HFN Commercial |
$6,868.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,599.62
|
| Rate for Payer: Multiplan Commercial |
$5,972.93
|
| Rate for Payer: NAPHCARE Commercial |
$4,479.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,868.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,658.42
|
| Rate for Payer: Quartz Commercial |
$4,853.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,479.70
|
| Rate for Payer: The Alliance Commercial |
$3,733.08
|
| Rate for Payer: WEA Trust Commercial |
$4,106.39
|
| Rate for Payer: WPS Commercial |
$5,529.98
|
|
|
FOOT RING SHORT 155MM 4934-5-155
|
Facility
|
OP
|
$9,770.00
|
|
| Hospital Charge Code |
5685888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,845.02 |
| Max. Negotiated Rate |
$9,347.94 |
| Rate for Payer: Aetna Commercial |
$9,144.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,738.29
|
| Rate for Payer: Aetna Managed Medicare |
$2,845.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,604.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,080.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,877.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,385.22
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$9,347.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,686.14
|
| Rate for Payer: Health EOS Commercial |
$9,043.11
|
| Rate for Payer: HFN Commercial |
$9,347.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,620.60
|
| Rate for Payer: Multiplan Commercial |
$8,128.64
|
| Rate for Payer: NAPHCARE Commercial |
$6,096.48
|
| Rate for Payer: Preferred Network Access Commercial |
$9,347.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,978.79
|
| Rate for Payer: Quartz Commercial |
$6,604.52
|
| Rate for Payer: Quartz Medicare Advantage |
$6,096.48
|
| Rate for Payer: The Alliance Commercial |
$5,080.40
|
| Rate for Payer: WEA Trust Commercial |
$5,588.44
|
| Rate for Payer: WPS Commercial |
$7,525.83
|
|
|
FOOT RING SHORT 155MM 4934-5-155
|
Facility
|
IP
|
$9,770.00
|
|
| Hospital Charge Code |
5685888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,978.79 |
| Max. Negotiated Rate |
$9,347.94 |
| Rate for Payer: Aetna Commercial |
$9,144.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,738.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,385.22
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$9,347.94
|
| Rate for Payer: Health EOS Commercial |
$9,043.11
|
| Rate for Payer: HFN Commercial |
$9,347.94
|
| Rate for Payer: Multiplan Commercial |
$8,128.64
|
| Rate for Payer: Preferred Network Access Commercial |
$9,347.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,978.79
|
| Rate for Payer: Quartz Commercial |
$6,096.48
|
| Rate for Payer: WEA Trust Commercial |
$5,588.44
|
| Rate for Payer: WPS Commercial |
$7,525.83
|
|
|
FOOT RING SHORT 180MM 4934-3-180
|
Facility
|
IP
|
$6,903.00
|
|
| Hospital Charge Code |
6226128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,517.77 |
| Max. Negotiated Rate |
$6,604.79 |
| Rate for Payer: Aetna Commercial |
$6,461.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,174.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,804.93
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Cigna Commercial |
$6,604.79
|
| Rate for Payer: Health EOS Commercial |
$6,389.42
|
| Rate for Payer: HFN Commercial |
$6,604.79
|
| Rate for Payer: Multiplan Commercial |
$5,743.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,604.79
|
| Rate for Payer: Quartz Beloit One Network |
$3,517.77
|
| Rate for Payer: Quartz Commercial |
$4,307.47
|
| Rate for Payer: WEA Trust Commercial |
$3,948.52
|
| Rate for Payer: WPS Commercial |
$5,317.38
|
|
|
FOOT RING SHORT 180MM 4934-3-180
|
Facility
|
OP
|
$6,903.00
|
|
| Hospital Charge Code |
6226128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,010.15 |
| Max. Negotiated Rate |
$6,604.79 |
| Rate for Payer: Aetna Commercial |
$6,461.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,174.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,010.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,666.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,589.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,445.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,804.93
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Cigna Commercial |
$6,604.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,017.55
|
| Rate for Payer: Health EOS Commercial |
$6,389.42
|
| Rate for Payer: HFN Commercial |
$6,604.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,384.34
|
| Rate for Payer: Multiplan Commercial |
$5,743.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,307.47
|
| Rate for Payer: Preferred Network Access Commercial |
$6,604.79
|
| Rate for Payer: Quartz Beloit One Network |
$3,517.77
|
| Rate for Payer: Quartz Commercial |
$4,666.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4,307.47
|
| Rate for Payer: The Alliance Commercial |
$3,589.56
|
| Rate for Payer: WEA Trust Commercial |
$3,948.52
|
| Rate for Payer: WPS Commercial |
$5,317.38
|
|
|
FOOT SPLINT ANKLE LEFT
|
Facility
|
OP
|
$801.00
|
|
| Hospital Charge Code |
2971656
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Aetna Managed Medicare |
$233.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$466.18
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.78
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: NAPHCARE Commercial |
$499.82
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$541.48
|
| Rate for Payer: Quartz Medicare Advantage |
$499.82
|
| Rate for Payer: The Alliance Commercial |
$416.52
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
FOOT SPLINT ANKLE LEFT
|
Facility
|
IP
|
$801.00
|
|
| Hospital Charge Code |
2971656
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$408.19 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$499.82
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
FOOT SPLINT ANKLE RIGHT
|
Facility
|
OP
|
$801.00
|
|
| Hospital Charge Code |
2971655
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Aetna Managed Medicare |
$233.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$466.18
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.78
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: NAPHCARE Commercial |
$499.82
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$541.48
|
| Rate for Payer: Quartz Medicare Advantage |
$499.82
|
| Rate for Payer: The Alliance Commercial |
$416.52
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
FOOT SPLINT ANKLE RIGHT
|
Facility
|
IP
|
$801.00
|
|
| Hospital Charge Code |
2971655
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$408.19 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$499.82
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
