|
zzzINCISION AND DRAINAGE, TOE
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960143
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, WRIST
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960144
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, WRIST
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960144
|
|
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
|
|
|
zzzINSERTION DRAIN
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960156
|
|
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
|
|
|
zzzINSERTION DRAIN
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960156
|
|
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
|
|
|
zzzINTERTROCHANTERIC TITANIUM FEMORAL NAILING, REMOVAL
|
Facility
IP
|
$5,427.00
|
|
| Hospital Charge Code |
2960429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,659.23 |
| Max. Negotiated Rate |
$4,992.84 |
| Rate for Payer: Aetna Commercial |
$4,884.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,876.31
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cigna Commercial |
$4,992.84
|
| Rate for Payer: Health EOS Commercial |
$4,830.03
|
| Rate for Payer: HFN Commercial |
$4,992.84
|
| Rate for Payer: Multiplan Commercial |
$4,341.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,992.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,659.23
|
| Rate for Payer: Quartz Commercial |
$3,256.20
|
| Rate for Payer: WEA Trust Commercial |
$2,984.85
|
| Rate for Payer: WPS Commercial |
$4,019.78
|
|
|
zzzINTERTROCHANTERIC TITANIUM FEMORAL NAILING, REMOVAL
|
Facility
OP
|
$5,427.00
|
|
| Hospital Charge Code |
2960429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,519.56 |
| Max. Negotiated Rate |
$21,708.00 |
| Rate for Payer: Aetna Commercial |
$4,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,667.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,519.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,527.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,713.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,604.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,876.31
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cigna Commercial |
$4,992.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,036.95
|
| Rate for Payer: Health EOS Commercial |
$4,830.03
|
| Rate for Payer: HFN Commercial |
$4,992.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,070.25
|
| Rate for Payer: Multiplan Commercial |
$4,341.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,992.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,659.23
|
| Rate for Payer: Quartz Commercial |
$3,527.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,256.20
|
| Rate for Payer: The Alliance Commercial |
$21,708.00
|
| Rate for Payer: WEA Trust Commercial |
$2,984.85
|
| Rate for Payer: WPS Commercial |
$4,019.78
|
|
|
zzzISTENT INJECT WITH 2 EYE STENTS G2-M-IS-USzzz
|
Facility
IP
|
$11,835.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
5415565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,799.15 |
| Max. Negotiated Rate |
$10,888.20 |
| Rate for Payer: Aetna Commercial |
$10,651.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,272.55
|
| Rate for Payer: Cash Price |
$3,550.50
|
| Rate for Payer: Cigna Commercial |
$10,888.20
|
| Rate for Payer: Health EOS Commercial |
$10,533.15
|
| Rate for Payer: HFN Commercial |
$10,888.20
|
| Rate for Payer: Multiplan Commercial |
$9,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,101.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,888.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,799.15
|
| Rate for Payer: Quartz Commercial |
$7,101.00
|
| Rate for Payer: WEA Trust Commercial |
$6,509.25
|
| Rate for Payer: WPS Commercial |
$8,766.18
|
|
|
zzzISTENT INJECT WITH 2 EYE STENTS G2-M-IS-USzzz
|
Facility
OP
|
$11,835.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
5415565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.80 |
| Max. Negotiated Rate |
$10,888.20 |
| Rate for Payer: Aetna Commercial |
$10,651.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,178.10
|
| Rate for Payer: Aetna Managed Medicare |
$3,313.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,692.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,917.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,680.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,272.55
|
| Rate for Payer: Cash Price |
$3,550.50
|
| Rate for Payer: Cigna Commercial |
$10,888.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,622.87
|
| Rate for Payer: Health EOS Commercial |
$10,533.15
|
| Rate for Payer: HFN Commercial |
$10,888.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,876.25
|
| Rate for Payer: Multiplan Commercial |
$9,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,101.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,888.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,799.15
|
| Rate for Payer: Quartz Commercial |
$7,692.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,101.00
|
| Rate for Payer: WEA Trust Commercial |
$6,509.25
|
| Rate for Payer: WPS Commercial |
$8,766.18
|
|
|
zzzJEJUNOSTOMY TUBE PLACEMENT
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960161
|
|
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
|
|
|
zzzJEJUNOSTOMY TUBE PLACEMENT
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960161
|
|
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
|
|
|
zzzKNEE ARTHRODESIS
|
Facility
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
zzzKNEE ARTHRODESIS
|
Facility
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
zzzKNEE OSTEOTOMY
|
Facility
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| 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: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| 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 |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
zzzKNEE OSTEOTOMY
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960292
|
|
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
|
|
|
ZZZ KNOT PUSHER/SUTURE CUTTER AR-5815 ZZZ DISC ZZZ
|
Facility
OP
|
$3,053.00
|
|
| Hospital Charge Code |
2964711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$854.84 |
| Max. Negotiated Rate |
$12,212.00 |
| Rate for Payer: Aetna Commercial |
$2,747.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.58
|
| Rate for Payer: Aetna Managed Medicare |
$854.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,984.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,526.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,465.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,618.09
|
| Rate for Payer: Cash Price |
$915.90
|
| Rate for Payer: Cigna Commercial |
$2,808.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,708.46
|
| Rate for Payer: Health EOS Commercial |
$2,717.17
|
| Rate for Payer: HFN Commercial |
$2,808.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,289.75
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,831.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,808.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,495.97
|
| Rate for Payer: Quartz Commercial |
$1,984.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,831.80
|
| Rate for Payer: The Alliance Commercial |
$12,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,679.15
|
| Rate for Payer: WPS Commercial |
$2,261.36
|
|
|
ZZZ KNOT PUSHER/SUTURE CUTTER AR-5815 ZZZ DISC ZZZ
|
Facility
IP
|
$3,053.00
|
|
| Hospital Charge Code |
2964711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,495.97 |
| Max. Negotiated Rate |
$2,808.76 |
| Rate for Payer: Aetna Commercial |
$2,747.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,618.09
|
| Rate for Payer: Cash Price |
$915.90
|
| Rate for Payer: Cigna Commercial |
$2,808.76
|
| Rate for Payer: Health EOS Commercial |
$2,717.17
|
| Rate for Payer: HFN Commercial |
$2,808.76
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,831.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,808.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,495.97
|
| Rate for Payer: Quartz Commercial |
$1,831.80
|
| Rate for Payer: WEA Trust Commercial |
$1,679.15
|
| Rate for Payer: WPS Commercial |
$2,261.36
|
|
|
zzzLACRIMAL DUCT PROBING
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960168
|
|
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
|
|
|
zzzLACRIMAL DUCT PROBING
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960168
|
|
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
|
|
|
zzzLACRIMAL LACERATION
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960169
|
|
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
|
|
|
zzzLACRIMAL LACERATION
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960169
|
|
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
|
|
|
zzzLAPAROSCOPIC GASTRIC BANDING
|
Facility
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.64 |
| Max. Negotiated Rate |
$26,852.00 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,363.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,356.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,756.59
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.75
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,363.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,027.80
|
| Rate for Payer: The Alliance Commercial |
$26,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
zzzLAPAROSCOPIC GASTRIC BANDING
|
Facility
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,289.37 |
| Max. Negotiated Rate |
$6,175.96 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,027.80
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
zzzLAPAROSCOPIC NISSEN FUNDOPLICATION
|
Facility
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960182
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,289.37 |
| Max. Negotiated Rate |
$6,175.96 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,027.80
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
zzzLAPAROSCOPIC NISSEN FUNDOPLICATION
|
Facility
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960182
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.64 |
| Max. Negotiated Rate |
$26,852.00 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,363.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,356.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,756.59
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.75
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,363.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,027.80
|
| Rate for Payer: The Alliance Commercial |
$26,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
