|
Foot cradle - Devices and Equipment
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
3002381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| 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: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| 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 |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
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 |
$49.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Aetna Managed Medicare |
$49.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.93
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$113.75
|
| Rate for Payer: Quartz Medicare Advantage |
$105.00
|
| Rate for Payer: The Alliance Commercial |
$700.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
Foot Insert Long/Met Support L3020
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS L3020
|
| Hospital Charge Code |
5571973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$703.03 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.00
|
| Rate for Payer: Health EOS Commercial |
$159.25
|
| Rate for Payer: HFN Commercial |
$166.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$703.03
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$166.25
|
| Rate for Payer: Quartz Beloit One Network |
$77.00
|
| Rate for Payer: Quartz Commercial |
$99.75
|
| Rate for Payer: The Alliance Commercial |
$87.50
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
Foot Insert Long/Met Support L3020
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS L3020
|
| Hospital Charge Code |
5571973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
FOOT OSTEOTOMY
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
FOOT OSTEOTOMY
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
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 |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
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 |
$29.90 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$38.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$83.40
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
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 |
$61.16 |
| Max. Negotiated Rate |
$180.24 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: HFN Commercial |
$132.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.24
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$46,237.00
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$16,632.03 |
| Max. Negotiated Rate |
$46,237.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,632.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,295.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,820.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,430.94
|
| Rate for Payer: Anthem Medicare Advantage |
$16,632.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,632.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,632.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,632.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,340.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,632.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,678.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,632.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,632.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,632.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,632.03
|
| Rate for Payer: NAPHCARE Commercial |
$24,948.04
|
| Rate for Payer: Quartz Medicare Advantage |
$16,632.03
|
| Rate for Payer: The Alliance Commercial |
$46,237.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,632.03
|
| Rate for Payer: United Healthcare PPO |
$26,219.11
|
| Rate for Payer: Wellcare Medicare |
$16,632.03
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$71,621.00
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$25,763.07 |
| Max. Negotiated Rate |
$71,621.00 |
| Rate for Payer: Aetna Managed Medicare |
$25,763.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,226.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,097.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,945.04
|
| Rate for Payer: Anthem Medicare Advantage |
$25,763.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,763.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,763.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,763.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,452.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,763.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52,297.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,763.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,763.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,763.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,763.07
|
| Rate for Payer: NAPHCARE Commercial |
$38,644.60
|
| Rate for Payer: Quartz Medicare Advantage |
$25,763.07
|
| Rate for Payer: The Alliance Commercial |
$71,621.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,763.07
|
| Rate for Payer: United Healthcare PPO |
$40,713.92
|
| Rate for Payer: Wellcare Medicare |
$25,763.07
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$45,668.00
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$16,427.39 |
| Max. Negotiated Rate |
$45,668.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,427.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,875.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,498.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,125.38
|
| Rate for Payer: Anthem Medicare Advantage |
$16,427.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,427.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,427.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,427.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,001.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,427.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,261.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,427.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,427.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,427.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,427.39
|
| Rate for Payer: NAPHCARE Commercial |
$24,641.08
|
| Rate for Payer: Quartz Medicare Advantage |
$16,427.39
|
| Rate for Payer: The Alliance Commercial |
$45,668.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,427.39
|
| Rate for Payer: United Healthcare PPO |
$25,894.23
|
| Rate for Payer: Wellcare Medicare |
$16,427.39
|
|
|
FOOT RING LONG 140MM 4934-2-140
|
Facility
|
IP
|
$6,946.00
|
|
| Hospital Charge Code |
6001641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,403.54 |
| Max. Negotiated Rate |
$6,390.32 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,681.38
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,167.60
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
FOOT RING LONG 140MM 4934-2-140
|
Facility
|
OP
|
$6,946.00
|
|
| Hospital Charge Code |
6001641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,944.88 |
| Max. Negotiated Rate |
$27,784.00 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,944.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,514.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,473.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,334.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,681.38
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,886.98
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,209.50
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,514.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,167.60
|
| Rate for Payer: The Alliance Commercial |
$27,784.00
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
FOOT RING LONG 155MM 4934-2-155
|
Facility
|
OP
|
$6,946.00
|
|
| Hospital Charge Code |
5611675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,944.88 |
| Max. Negotiated Rate |
$27,784.00 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,944.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,514.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,473.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,334.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,681.38
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,886.98
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,209.50
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,514.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,167.60
|
| Rate for Payer: The Alliance Commercial |
$27,784.00
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
FOOT RING LONG 155MM 4934-2-155
|
Facility
|
IP
|
$6,946.00
|
|
| Hospital Charge Code |
5611675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,403.54 |
| Max. Negotiated Rate |
$6,390.32 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,681.38
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,167.60
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
FOOT RING LONG 180MM 4934-2-180
|
Facility
|
OP
|
$7,511.00
|
|
| Hospital Charge Code |
5603593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,103.08 |
| Max. Negotiated Rate |
$30,044.00 |
| Rate for Payer: Aetna Commercial |
$6,759.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,459.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,103.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,882.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,755.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,605.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.83
|
| Rate for Payer: Cash Price |
$2,253.30
|
| Rate for Payer: Cigna Commercial |
$6,910.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,203.16
|
| Rate for Payer: Health EOS Commercial |
$6,684.79
|
| Rate for Payer: HFN Commercial |
$6,910.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,633.25
|
| Rate for Payer: Multiplan Commercial |
$6,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,910.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,680.39
|
| Rate for Payer: Quartz Commercial |
$4,882.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,506.60
|
| Rate for Payer: The Alliance Commercial |
$30,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,131.05
|
| Rate for Payer: WPS Commercial |
$5,563.40
|
|
|
FOOT RING LONG 180MM 4934-2-180
|
Facility
|
IP
|
$7,511.00
|
|
| Hospital Charge Code |
5603593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,680.39 |
| Max. Negotiated Rate |
$6,910.12 |
| Rate for Payer: Aetna Commercial |
$6,759.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,459.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.83
|
| Rate for Payer: Cash Price |
$2,253.30
|
| Rate for Payer: Cigna Commercial |
$6,910.12
|
| Rate for Payer: Health EOS Commercial |
$6,684.79
|
| Rate for Payer: HFN Commercial |
$6,910.12
|
| Rate for Payer: Multiplan Commercial |
$6,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,910.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,680.39
|
| Rate for Payer: Quartz Commercial |
$4,506.60
|
| Rate for Payer: WEA Trust Commercial |
$4,131.05
|
| Rate for Payer: WPS Commercial |
$5,563.40
|
|
|
FOOT RING SHORT 155MM 4934-3-155
|
Facility
|
IP
|
$7,179.00
|
|
| Hospital Charge Code |
6065670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,517.71 |
| Max. Negotiated Rate |
$6,604.68 |
| Rate for Payer: Aetna Commercial |
$6,461.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,173.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,804.87
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cigna Commercial |
$6,604.68
|
| Rate for Payer: Health EOS Commercial |
$6,389.31
|
| Rate for Payer: HFN Commercial |
$6,604.68
|
| Rate for Payer: Multiplan Commercial |
$5,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,604.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,517.71
|
| Rate for Payer: Quartz Commercial |
$4,307.40
|
| Rate for Payer: WEA Trust Commercial |
$3,948.45
|
| Rate for Payer: WPS Commercial |
$5,317.49
|
|
|
FOOT RING SHORT 155MM 4934-3-155
|
Facility
|
OP
|
$7,179.00
|
|
| Hospital Charge Code |
6065670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,010.12 |
| Max. Negotiated Rate |
$28,716.00 |
| Rate for Payer: Aetna Commercial |
$6,461.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,173.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,010.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,666.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,589.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,445.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,804.87
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Cigna Commercial |
$6,604.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,017.37
|
| Rate for Payer: Health EOS Commercial |
$6,389.31
|
| Rate for Payer: HFN Commercial |
$6,604.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,384.25
|
| Rate for Payer: Multiplan Commercial |
$5,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,604.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,517.71
|
| Rate for Payer: Quartz Commercial |
$4,666.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,307.40
|
| Rate for Payer: The Alliance Commercial |
$28,716.00
|
| Rate for Payer: WEA Trust Commercial |
$3,948.45
|
| Rate for Payer: WPS Commercial |
$5,317.49
|
|
|
FOOT RING SHORT 155MM 4934-5-155
|
Facility
|
OP
|
$9,770.00
|
|
| Hospital Charge Code |
5685888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,735.60 |
| Max. Negotiated Rate |
$39,080.00 |
| Rate for Payer: Aetna Commercial |
$8,793.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,402.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,735.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,350.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,885.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,689.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,178.10
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$8,988.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,467.29
|
| Rate for Payer: Health EOS Commercial |
$8,695.30
|
| Rate for Payer: HFN Commercial |
$8,988.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,327.50
|
| Rate for Payer: Multiplan Commercial |
$7,816.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,862.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,988.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,787.30
|
| Rate for Payer: Quartz Commercial |
$6,350.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,862.00
|
| Rate for Payer: The Alliance Commercial |
$39,080.00
|
| Rate for Payer: WEA Trust Commercial |
$5,373.50
|
| Rate for Payer: WPS Commercial |
$7,236.64
|
|
|
FOOT RING SHORT 155MM 4934-5-155
|
Facility
|
IP
|
$9,770.00
|
|
| Hospital Charge Code |
5685888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,787.30 |
| Max. Negotiated Rate |
$8,988.40 |
| Rate for Payer: Aetna Commercial |
$8,793.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,402.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,178.10
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$8,988.40
|
| Rate for Payer: Health EOS Commercial |
$8,695.30
|
| Rate for Payer: HFN Commercial |
$8,988.40
|
| Rate for Payer: Multiplan Commercial |
$7,816.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,862.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,988.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,787.30
|
| Rate for Payer: Quartz Commercial |
$5,862.00
|
| Rate for Payer: WEA Trust Commercial |
$5,373.50
|
| Rate for Payer: WPS Commercial |
$7,236.64
|
|
|
FOOT RING SHORT 180MM 4934-3-180
|
Facility
|
IP
|
$6,903.00
|
|
| Hospital Charge Code |
6226128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,382.47 |
| Max. Negotiated Rate |
$6,350.76 |
| Rate for Payer: Aetna Commercial |
$6,212.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,936.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,658.59
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Cigna Commercial |
$6,350.76
|
| Rate for Payer: Health EOS Commercial |
$6,143.67
|
| Rate for Payer: HFN Commercial |
$6,350.76
|
| Rate for Payer: Multiplan Commercial |
$5,522.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,141.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,350.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,382.47
|
| Rate for Payer: Quartz Commercial |
$4,141.80
|
| Rate for Payer: WEA Trust Commercial |
$3,796.65
|
| Rate for Payer: WPS Commercial |
$5,113.05
|
|
|
FOOT RING SHORT 180MM 4934-3-180
|
Facility
|
OP
|
$6,903.00
|
|
| Hospital Charge Code |
6226128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,932.84 |
| Max. Negotiated Rate |
$27,612.00 |
| Rate for Payer: Aetna Commercial |
$6,212.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,936.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,932.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,486.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,451.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,313.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,658.59
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Cigna Commercial |
$6,350.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,862.92
|
| Rate for Payer: Health EOS Commercial |
$6,143.67
|
| Rate for Payer: HFN Commercial |
$6,350.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,177.25
|
| Rate for Payer: Multiplan Commercial |
$5,522.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,141.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,350.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,382.47
|
| Rate for Payer: Quartz Commercial |
$4,486.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,141.80
|
| Rate for Payer: The Alliance Commercial |
$27,612.00
|
| Rate for Payer: WEA Trust Commercial |
$3,796.65
|
| Rate for Payer: WPS Commercial |
$5,113.05
|
|
|
FOOT SPLINT ANKLE LEFT
|
Facility
|
IP
|
$801.00
|
|
| Hospital Charge Code |
2971656
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$392.49 |
| Max. Negotiated Rate |
$736.92 |
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.53
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$736.92
|
| Rate for Payer: Health EOS Commercial |
$712.89
|
| Rate for Payer: HFN Commercial |
$736.92
|
| Rate for Payer: Multiplan Commercial |
$640.80
|
| Rate for Payer: NAPHCARE Commercial |
$480.60
|
| Rate for Payer: Preferred Network Access Commercial |
$736.92
|
| Rate for Payer: Quartz Beloit One Network |
$392.49
|
| Rate for Payer: Quartz Commercial |
$480.60
|
| Rate for Payer: WEA Trust Commercial |
$440.55
|
| Rate for Payer: WPS Commercial |
$593.30
|
|
