|
VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
|
Facility
|
OP
|
$99.58
|
|
|
Service Code
|
EAPG 00561
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$99.58 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$95.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.75
|
| Rate for Payer: Dean Health Medicaid |
$95.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$95.75
|
| Rate for Payer: Managed Health Services Medicaid |
$99.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$95.75
|
| Rate for Payer: United Healthcare Medicaid |
$95.75
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$8,592.94
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$7,632.79 |
| Max. Negotiated Rate |
$8,592.94 |
| Rate for Payer: Anthem Medicaid |
$8,228.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,228.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,228.22
|
| Rate for Payer: Dean Health Medicaid |
$8,228.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,632.79
|
| Rate for Payer: Managed Health Services Medicaid |
$8,592.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,228.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,228.22
|
| Rate for Payer: United Healthcare Medicaid |
$8,228.22
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$14,906.13
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$13,240.55 |
| Max. Negotiated Rate |
$14,906.13 |
| Rate for Payer: Anthem Medicaid |
$14,273.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,273.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,273.44
|
| Rate for Payer: Dean Health Medicaid |
$14,273.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,240.55
|
| Rate for Payer: Managed Health Services Medicaid |
$14,906.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,273.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,273.44
|
| Rate for Payer: United Healthcare Medicaid |
$14,273.44
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
Very Long Chain Fatty Acids / 90559
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$399.15 |
| Rate for Payer: Aetna Commercial |
$399.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$20.54
|
| Rate for Payer: Anthem Medicare Advantage |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.54
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$399.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.54
|
| Rate for Payer: Health EOS Commercial |
$382.35
|
| Rate for Payer: HFN Commercial |
$399.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$30.81
|
| Rate for Payer: Preferred Network Access Commercial |
$399.15
|
| Rate for Payer: Quartz Beloit One Network |
$184.87
|
| Rate for Payer: Quartz Commercial |
$239.49
|
| Rate for Payer: Quartz Medicare Advantage |
$20.54
|
| Rate for Payer: The Alliance Commercial |
$81.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.54
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$90.38
|
|
|
Very Long Chain Fatty Acids / 90559
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
Very Long Chain Fatty Acids / 90559
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$20.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.10
|
| Rate for Payer: Anthem Medicare Advantage |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.54
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.54
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$30.81
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$20.54
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.54
|
| Rate for Payer: United Healthcare PPO |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: Wellcare Medicare |
$20.54
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
VESICOVAGINAL FISTULA CLOSURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESICOVAGINAL FISTULA CLOSURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP LARGE 4008-07
|
Facility
|
IP
|
$6,077.00
|
|
| Hospital Charge Code |
5298748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,096.84 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$3,792.05
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP LARGE 4008-07
|
Facility
|
OP
|
$6,077.00
|
|
| Hospital Charge Code |
5298748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,108.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,160.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP MEDIUM 4008-06
|
Facility
|
IP
|
$6,077.00
|
|
| Hospital Charge Code |
5298747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,096.84 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$3,792.05
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP MEDIUM 4008-06
|
Facility
|
OP
|
$6,077.00
|
|
| Hospital Charge Code |
5298747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,108.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,160.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
VESSELOOP BLUE MINI SMALL DYNJVL11
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
VESSELOOP BLUE MINI SMALL DYNJVL11
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
VESSELOOP YELLOW MAXI REG DYNJVL04
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
VESSELOOP YELLOW MAXI REG DYNJVL04
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
VEST LARGE AIRWAY CLEARAN #P3006320000
|
Facility
|
OP
|
$1,484.00
|
|
| Hospital Charge Code |
2972306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Aetna Managed Medicare |
$432.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.69
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.52
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: NAPHCARE Commercial |
$926.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$1,003.18
|
| Rate for Payer: Quartz Medicare Advantage |
$926.02
|
| Rate for Payer: The Alliance Commercial |
$771.68
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
VEST LARGE AIRWAY CLEARAN #P3006320000
|
Facility
|
IP
|
$1,484.00
|
|
| Hospital Charge Code |
2972306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.25 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$926.02
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
VEST MEDIUM AIRWAY CLEARA #P3006310000
|
Facility
|
IP
|
$1,484.00
|
|
| Hospital Charge Code |
2972305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.25 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$926.02
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
VEST MEDIUM AIRWAY CLEARA #P3006310000
|
Facility
|
OP
|
$1,484.00
|
|
| Hospital Charge Code |
2972305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Aetna Managed Medicare |
$432.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.69
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.52
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: NAPHCARE Commercial |
$926.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$1,003.18
|
| Rate for Payer: Quartz Medicare Advantage |
$926.02
|
| Rate for Payer: The Alliance Commercial |
$771.68
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
VEST SMALL AIRWAY CLEARAN #P300630000
|
Facility
|
OP
|
$1,484.00
|
|
| Hospital Charge Code |
2972254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Aetna Managed Medicare |
$432.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.69
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.52
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: NAPHCARE Commercial |
$926.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$1,003.18
|
| Rate for Payer: Quartz Medicare Advantage |
$926.02
|
| Rate for Payer: The Alliance Commercial |
$771.68
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
