|
zzzFREE FLAP
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960075
|
|
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
|
|
|
zzzFRENOTOMY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960078
|
|
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
|
|
|
zzzFRENOTOMY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960078
|
|
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
|
|
|
zzzFRENULECTOMY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960077
|
|
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
|
|
|
zzzFRENULECTOMY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960077
|
|
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
|
|
|
zzzGASTRIC RESECTION
|
Facility
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960084
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
zzzGASTRIC RESECTION
|
Facility
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960084
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
ZZZ***GRASPING FORCEP TRICEP 3FR X 120 EXTRA STRENGTH M0063701230***DISC***
|
Facility
OP
|
$2,643.00
|
|
| Hospital Charge Code |
4595195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.04 |
| Max. Negotiated Rate |
$10,572.00 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,272.98
|
| Rate for Payer: Aetna Managed Medicare |
$740.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,717.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,321.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,268.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.79
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna Commercial |
$2,431.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,479.02
|
| Rate for Payer: Health EOS Commercial |
$2,352.27
|
| Rate for Payer: HFN Commercial |
$2,431.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,982.25
|
| Rate for Payer: Multiplan Commercial |
$2,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,585.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,431.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.07
|
| Rate for Payer: Quartz Commercial |
$1,717.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,585.80
|
| Rate for Payer: The Alliance Commercial |
$10,572.00
|
| Rate for Payer: WEA Trust Commercial |
$1,453.65
|
| Rate for Payer: WPS Commercial |
$1,957.67
|
|
|
ZZZ***GRASPING FORCEP TRICEP 3FR X 120 EXTRA STRENGTH M0063701230***DISC***
|
Facility
IP
|
$2,643.00
|
|
| Hospital Charge Code |
4595195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,295.07 |
| Max. Negotiated Rate |
$2,431.56 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.79
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna Commercial |
$2,431.56
|
| Rate for Payer: Health EOS Commercial |
$2,352.27
|
| Rate for Payer: HFN Commercial |
$2,431.56
|
| Rate for Payer: Multiplan Commercial |
$2,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,585.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,431.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.07
|
| Rate for Payer: Quartz Commercial |
$1,585.80
|
| Rate for Payer: WEA Trust Commercial |
$1,453.65
|
| Rate for Payer: WPS Commercial |
$1,957.67
|
|
|
zzzGUIDEWIRE ASAHI FIELDER FC 300CM ** discontinued note to Staci
|
Facility
OP
|
$3,552.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.56 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$3,196.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.72
|
| Rate for Payer: Aetna Managed Medicare |
$994.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,308.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.56
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$3,267.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,987.70
|
| Rate for Payer: Health EOS Commercial |
$3,161.28
|
| Rate for Payer: HFN Commercial |
$3,267.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,664.00
|
| Rate for Payer: Multiplan Commercial |
$2,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.48
|
| Rate for Payer: Quartz Commercial |
$2,308.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,131.20
|
| Rate for Payer: WEA Trust Commercial |
$1,953.60
|
| Rate for Payer: WPS Commercial |
$2,630.97
|
|
|
zzzGUIDEWIRE ASAHI FIELDER FC 300CM ** discontinued note to Staci
|
Facility
IP
|
$3,552.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,740.48 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$3,196.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.56
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$3,267.84
|
| Rate for Payer: Health EOS Commercial |
$3,161.28
|
| Rate for Payer: HFN Commercial |
$3,267.84
|
| Rate for Payer: Multiplan Commercial |
$2,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.48
|
| Rate for Payer: Quartz Commercial |
$2,131.20
|
| Rate for Payer: WEA Trust Commercial |
$1,953.60
|
| Rate for Payer: WPS Commercial |
$2,630.97
|
|
|
zzzHALLUX VALGUS CORRECTION
|
Facility
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2960096
|
|
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
|
|
|
zzzHALLUX VALGUS CORRECTION
|
Facility
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2960096
|
|
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
|
|
|
zzzHAND FASCIOTOMY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960051
|
|
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
|
|
|
zzzHAND FASCIOTOMY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960051
|
|
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
|
|
|
zzzHEEL DEFORMITY
|
Facility
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2960101
|
|
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
|
|
|
zzzHEEL DEFORMITY
|
Facility
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2960101
|
|
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
|
|
|
zzzHEMORRHOID BANDING
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960106
|
|
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
|
|
|
zzzHEMORRHOID BANDING
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| 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: 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
|
|
|
zzzHEMORRHOIDECTOMY, STAPLED
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960107
|
|
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
|
|
|
zzzHEMORRHOIDECTOMY, STAPLED
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960107
|
|
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
|
|
|
zzzHEMORRHOIDPEXY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960105
|
|
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
|
|
|
zzzHEMORRHOIDPEXY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960105
|
|
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
|
|
|
zzzHERNIA REPAIR, DIAPHRAGMATIC
|
Facility
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960108
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
zzzHERNIA REPAIR, DIAPHRAGMATIC
|
Facility
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960108
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
