|
FO nontorsion joint CF L3935
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS L3935
|
| Hospital Charge Code |
3206212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$2,840.00 |
| Rate for Payer: Aetna Commercial |
$639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$610.60
|
| Rate for Payer: Aetna Managed Medicare |
$198.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.30
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$653.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$397.32
|
| Rate for Payer: Health EOS Commercial |
$631.90
|
| Rate for Payer: HFN Commercial |
$653.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$532.50
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: NAPHCARE Commercial |
$426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$653.20
|
| Rate for Payer: Quartz Beloit One Network |
$347.90
|
| Rate for Payer: Quartz Commercial |
$461.50
|
| Rate for Payer: Quartz Medicare Advantage |
$426.00
|
| Rate for Payer: The Alliance Commercial |
$2,840.00
|
| Rate for Payer: WEA Trust Commercial |
$390.50
|
| Rate for Payer: WPS Commercial |
$525.90
|
|
|
FO nontorsion joint CF L3935
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS L3935
|
| Hospital Charge Code |
3206212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$653.20 |
| Rate for Payer: Aetna Commercial |
$639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$610.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.30
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$653.20
|
| Rate for Payer: Health EOS Commercial |
$631.90
|
| Rate for Payer: HFN Commercial |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: NAPHCARE Commercial |
$426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$653.20
|
| Rate for Payer: Quartz Beloit One Network |
$347.90
|
| Rate for Payer: Quartz Commercial |
$426.00
|
| Rate for Payer: WEA Trust Commercial |
$390.50
|
| Rate for Payer: WPS Commercial |
$525.90
|
|
|
Foot Arch Support Adult, pair L3050
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS L3050
|
| Hospital Charge Code |
5544796
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$166.79 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.79
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Foot Arch Support Adult, pair L3050
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS L3050
|
| Hospital Charge Code |
5544796
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Foot Arch Support Adult, pair L3050
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS L3050
|
| Hospital Charge Code |
5544796
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Foot Arch Support Longitudinal L3010
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS L3010
|
| Hospital Charge Code |
3133682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Aetna Managed Medicare |
$78.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.25
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$182.65
|
| Rate for Payer: Quartz Medicare Advantage |
$168.60
|
| Rate for Payer: The Alliance Commercial |
$1,124.00
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Foot Arch Support Longitudinal L3010
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS L3010
|
| Hospital Charge Code |
3133682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$258.52 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$168.60
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Foot Arch Support Longitudinal L3010
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS L3010
|
| Hospital Charge Code |
3133682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.64 |
| Max. Negotiated Rate |
$617.36 |
| Rate for Payer: Aetna Commercial |
$266.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.60
|
| Rate for Payer: Health EOS Commercial |
$255.71
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$617.36
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$123.64
|
| Rate for Payer: Quartz Commercial |
$160.17
|
| Rate for Payer: The Alliance Commercial |
$140.50
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Foot Arch Support Peds, pair L3051
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
5544797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Foot Arch Support Peds, pair L3051
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
5544797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Foot Arch Support Peds, pair L3051
|
Professional
|
Both
|
$96.00
|
|
| Hospital Charge Code |
5544797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.60
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: HFN Commercial |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Foot Arch Support Remove Prem L3030
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS L3030
|
| Hospital Charge Code |
5162637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
Foot Arch Support Remove Prem L3030
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS L3030
|
| Hospital Charge Code |
5162637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$270.36 |
| Rate for Payer: Aetna Commercial |
$237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.00
|
| Rate for Payer: Health EOS Commercial |
$227.50
|
| Rate for Payer: HFN Commercial |
$237.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$270.36
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Preferred Network Access Commercial |
$237.50
|
| Rate for Payer: Quartz Beloit One Network |
$110.00
|
| Rate for Payer: Quartz Commercial |
$142.50
|
| Rate for Payer: The Alliance Commercial |
$125.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
Foot Arch Support Remove Prem L3030
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS L3030
|
| Hospital Charge Code |
5162637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Aetna Managed Medicare |
$70.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.90
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$162.50
|
| Rate for Payer: Quartz Medicare Advantage |
$150.00
|
| Rate for Payer: The Alliance Commercial |
$1,000.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
FOOT ARTHROSCOPY
|
Facility
|
OP
|
$7,950.00
|
|
| Hospital Charge Code |
2959828
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,226.00 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,837.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,226.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,167.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,816.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.50
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,314.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,448.82
|
| Rate for Payer: Health EOS Commercial |
$7,075.50
|
| Rate for Payer: HFN Commercial |
$7,314.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,962.50
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,314.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.50
|
| Rate for Payer: Quartz Commercial |
$5,167.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,770.00
|
| Rate for Payer: The Alliance Commercial |
$31,800.00
|
| Rate for Payer: WEA Trust Commercial |
$4,372.50
|
| Rate for Payer: WPS Commercial |
$5,888.56
|
|
|
FOOT ARTHROSCOPY
|
Facility
|
IP
|
$7,950.00
|
|
| Hospital Charge Code |
2959828
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,895.50 |
| Max. Negotiated Rate |
$7,314.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,837.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.50
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,314.00
|
| Rate for Payer: Health EOS Commercial |
$7,075.50
|
| Rate for Payer: HFN Commercial |
$7,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,314.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.50
|
| Rate for Payer: Quartz Commercial |
$4,770.00
|
| Rate for Payer: WEA Trust Commercial |
$4,372.50
|
| Rate for Payer: WPS Commercial |
$5,888.56
|
|
|
FOOT BOARD
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
3075879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
FOOT BOARD
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
3075879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Foot board - Devices and Equipment
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
3002384
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Foot board - Devices and Equipment
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
3002384
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
FOOT BUFFER #10
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2971913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
FOOT BUFFER #10
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2971913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
FOOT CRADEL
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
3075876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
FOOT CRADEL
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
3075876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Foot cradle - Devices and Equipment
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
3002381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.15
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
