|
zzzBICEPS TENDON REPAIR
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
zzzBIOPSY, EXCISIONAL
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959884
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
zzzBIOPSY, EXCISIONAL
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959884
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| 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
|
|
|
zzzBIOPSY, MASS
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959887
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
zzzBIOPSY, MASS
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959887
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| 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
|
|
|
zzzBIOPSY, PENIS
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| 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
|
|
|
zzzBIOPSY, PENIS
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
ZZZBLADE PRECISION SAW 6525-127-105ZZZOBSOLETE
|
Facility
IP
|
$2,242.00
|
|
| Hospital Charge Code |
2966101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,098.58 |
| Max. Negotiated Rate |
$2,062.64 |
| Rate for Payer: Aetna Commercial |
$2,017.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.26
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,062.64
|
| Rate for Payer: Health EOS Commercial |
$1,995.38
|
| Rate for Payer: HFN Commercial |
$2,062.64
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.58
|
| Rate for Payer: Quartz Commercial |
$1,345.20
|
| Rate for Payer: WEA Trust Commercial |
$1,233.10
|
| Rate for Payer: WPS Commercial |
$1,660.65
|
|
|
ZZZBLADE PRECISION SAW 6525-127-105ZZZOBSOLETE
|
Facility
OP
|
$2,242.00
|
|
| Hospital Charge Code |
2966101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.76 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Aetna Commercial |
$2,017.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.12
|
| Rate for Payer: Aetna Managed Medicare |
$627.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,457.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,121.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,076.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.26
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,062.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,254.62
|
| Rate for Payer: Health EOS Commercial |
$1,995.38
|
| Rate for Payer: HFN Commercial |
$2,062.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,681.50
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.58
|
| Rate for Payer: Quartz Commercial |
$1,457.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,345.20
|
| Rate for Payer: The Alliance Commercial |
$8,968.00
|
| Rate for Payer: WEA Trust Commercial |
$1,233.10
|
| Rate for Payer: WPS Commercial |
$1,660.65
|
|
|
zzzBLEB RESECTION
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzBLEB RESECTION
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzBLEPHARPTOSIS
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959852
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzBLEPHARPTOSIS
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959852
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzBRACHIAL PLEXUS SURGERY
|
Facility
IP
|
$12,095.00
|
|
| Hospital Charge Code |
2959872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,926.55 |
| Max. Negotiated Rate |
$11,127.40 |
| Rate for Payer: Aetna Commercial |
$10,885.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,410.35
|
| Rate for Payer: Cash Price |
$3,628.50
|
| Rate for Payer: Cigna Commercial |
$11,127.40
|
| Rate for Payer: Health EOS Commercial |
$10,764.55
|
| Rate for Payer: HFN Commercial |
$11,127.40
|
| Rate for Payer: Multiplan Commercial |
$9,676.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,257.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,127.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,926.55
|
| Rate for Payer: Quartz Commercial |
$7,257.00
|
| Rate for Payer: WEA Trust Commercial |
$6,652.25
|
| Rate for Payer: WPS Commercial |
$8,958.77
|
|
|
zzzBRACHIAL PLEXUS SURGERY
|
Facility
OP
|
$12,095.00
|
|
| Hospital Charge Code |
2959872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,386.60 |
| Max. Negotiated Rate |
$48,380.00 |
| Rate for Payer: Aetna Commercial |
$10,885.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,401.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,386.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,861.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,047.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,805.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,410.35
|
| Rate for Payer: Cash Price |
$3,628.50
|
| Rate for Payer: Cigna Commercial |
$11,127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,768.36
|
| Rate for Payer: Health EOS Commercial |
$10,764.55
|
| Rate for Payer: HFN Commercial |
$11,127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,071.25
|
| Rate for Payer: Multiplan Commercial |
$9,676.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,257.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,127.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,926.55
|
| Rate for Payer: Quartz Commercial |
$7,861.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,257.00
|
| Rate for Payer: The Alliance Commercial |
$48,380.00
|
| Rate for Payer: WEA Trust Commercial |
$6,652.25
|
| Rate for Payer: WPS Commercial |
$8,958.77
|
|
|
zzzBREAST RECONSTRUCTION
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959879
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzBREAST RECONSTRUCTION
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959879
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzBUNIONECTOMY, KELLER
|
Facility
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2950494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.68 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$979.20
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
zzzBUNIONECTOMY, KELLER
|
Facility
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2950494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.96 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,403.52
|
| Rate for Payer: Aetna Managed Medicare |
$456.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,060.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$783.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.27
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,224.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$1,060.80
|
| Rate for Payer: Quartz Medicare Advantage |
$979.20
|
| Rate for Payer: The Alliance Commercial |
$6,528.00
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
zzzBUNIONECTOMY, TAYLOR
|
Facility
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2950493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.68 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$979.20
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
zzzBUNIONECTOMY, TAYLOR
|
Facility
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2950493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.96 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,403.52
|
| Rate for Payer: Aetna Managed Medicare |
$456.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,060.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$783.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.27
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,224.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$1,060.80
|
| Rate for Payer: Quartz Medicare Advantage |
$979.20
|
| Rate for Payer: The Alliance Commercial |
$6,528.00
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
ZZZ***CABLE/CRIMP CABLE - READY 1.8MM X 25 2232-04-18***DO NOT USE ON PREF CARD***ZZZ"
|
Facility
IP
|
$4,590.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2967453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,249.10 |
| Max. Negotiated Rate |
$4,222.80 |
| Rate for Payer: Aetna Commercial |
$4,131.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,432.70
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$4,222.80
|
| Rate for Payer: Health EOS Commercial |
$4,085.10
|
| Rate for Payer: HFN Commercial |
$4,222.80
|
| Rate for Payer: Multiplan Commercial |
$3,672.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,754.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,222.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,249.10
|
| Rate for Payer: Quartz Commercial |
$2,754.00
|
| Rate for Payer: WEA Trust Commercial |
$2,524.50
|
| Rate for Payer: WPS Commercial |
$3,399.81
|
|
|
ZZZ***CABLE/CRIMP CABLE - READY 1.8MM X 25 2232-04-18***DO NOT USE ON PREF CARD***ZZZ"
|
Facility
OP
|
$4,590.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2967453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.24 |
| Max. Negotiated Rate |
$4,222.80 |
| Rate for Payer: Aetna Commercial |
$4,131.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,947.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,285.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,983.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,295.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,203.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,432.70
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$4,222.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,568.56
|
| Rate for Payer: Health EOS Commercial |
$4,085.10
|
| Rate for Payer: HFN Commercial |
$4,222.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,442.50
|
| Rate for Payer: Multiplan Commercial |
$3,672.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,754.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,222.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,249.10
|
| Rate for Payer: Quartz Commercial |
$2,983.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,754.00
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$2,524.50
|
| Rate for Payer: WPS Commercial |
$3,399.81
|
|
|
ZZZ***CANISTER W/GEL 500ML M8275063/5.S***DO NOT USE ON PICKLIST***ZZZ
|
Facility
IP
|
$869.00
|
|
| Hospital Charge Code |
3587513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.81 |
| Max. Negotiated Rate |
$799.48 |
| Rate for Payer: Aetna Commercial |
$782.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.57
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$799.48
|
| Rate for Payer: Health EOS Commercial |
$773.41
|
| Rate for Payer: HFN Commercial |
$799.48
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: NAPHCARE Commercial |
$521.40
|
| Rate for Payer: Preferred Network Access Commercial |
$799.48
|
| Rate for Payer: Quartz Beloit One Network |
$425.81
|
| Rate for Payer: Quartz Commercial |
$521.40
|
| Rate for Payer: WEA Trust Commercial |
$477.95
|
| Rate for Payer: WPS Commercial |
$643.67
|
|
|
ZZZ***CANISTER W/GEL 500ML M8275063/5.S***DO NOT USE ON PICKLIST***ZZZ
|
Facility
OP
|
$869.00
|
|
| Hospital Charge Code |
3587513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.32 |
| Max. Negotiated Rate |
$3,476.00 |
| Rate for Payer: Aetna Commercial |
$782.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.34
|
| Rate for Payer: Aetna Managed Medicare |
$243.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$564.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$434.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$417.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.57
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$799.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.29
|
| Rate for Payer: Health EOS Commercial |
$773.41
|
| Rate for Payer: HFN Commercial |
$799.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.75
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: NAPHCARE Commercial |
$521.40
|
| Rate for Payer: Preferred Network Access Commercial |
$799.48
|
| Rate for Payer: Quartz Beloit One Network |
$425.81
|
| Rate for Payer: Quartz Commercial |
$564.85
|
| Rate for Payer: Quartz Medicare Advantage |
$521.40
|
| Rate for Payer: The Alliance Commercial |
$3,476.00
|
| Rate for Payer: WEA Trust Commercial |
$477.95
|
| Rate for Payer: WPS Commercial |
$643.67
|
|
