|
zzzTYLECTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzTYLECTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960461
|
|
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
|
|
|
zzzTYMPANOMASTOIDECTOMY
|
Facility
|
OP
|
$5,030.00
|
|
| Hospital Charge Code |
2960462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,408.40 |
| Max. Negotiated Rate |
$20,120.00 |
| Rate for Payer: Aetna Commercial |
$4,527.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,408.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,269.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,515.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,414.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.90
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,627.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,814.79
|
| Rate for Payer: Health EOS Commercial |
$4,476.70
|
| Rate for Payer: HFN Commercial |
$4,627.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,772.50
|
| Rate for Payer: Multiplan Commercial |
$4,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,018.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.70
|
| Rate for Payer: Quartz Commercial |
$3,269.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,018.00
|
| Rate for Payer: The Alliance Commercial |
$20,120.00
|
| Rate for Payer: WEA Trust Commercial |
$2,766.50
|
| Rate for Payer: WPS Commercial |
$3,725.72
|
|
|
zzzTYMPANOMASTOIDECTOMY
|
Facility
|
IP
|
$5,030.00
|
|
| Hospital Charge Code |
2960462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,464.70 |
| Max. Negotiated Rate |
$4,627.60 |
| Rate for Payer: Aetna Commercial |
$4,527.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.90
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,627.60
|
| Rate for Payer: Health EOS Commercial |
$4,476.70
|
| Rate for Payer: HFN Commercial |
$4,627.60
|
| Rate for Payer: Multiplan Commercial |
$4,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,018.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.70
|
| Rate for Payer: Quartz Commercial |
$3,018.00
|
| Rate for Payer: WEA Trust Commercial |
$2,766.50
|
| Rate for Payer: WPS Commercial |
$3,725.72
|
|
|
zzzTYMPANOSTOMY WITH T-TUBES, BILATERAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959855
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzTYMPANOSTOMY WITH T-TUBES, BILATERAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959855
|
|
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
|
|
|
zzzURETEROTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960477
|
|
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
|
|
|
zzzURETEROTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960477
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| 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
|
|
|
zzzUVULOPLASTY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzUVULOPLASTY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960485
|
|
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
|
|
|
zzzVARICOSE VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$1,048.00
|
|
| Hospital Charge Code |
2960495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$513.52 |
| Max. Negotiated Rate |
$964.16 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.44
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$964.16
|
| Rate for Payer: Health EOS Commercial |
$932.72
|
| Rate for Payer: HFN Commercial |
$964.16
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: NAPHCARE Commercial |
$628.80
|
| Rate for Payer: Preferred Network Access Commercial |
$964.16
|
| Rate for Payer: Quartz Beloit One Network |
$513.52
|
| Rate for Payer: Quartz Commercial |
$628.80
|
| Rate for Payer: WEA Trust Commercial |
$576.40
|
| Rate for Payer: WPS Commercial |
$776.25
|
|
|
zzzVARICOSE VEIN LIGATION AND STRIPPING
|
Facility
|
OP
|
$1,048.00
|
|
| Hospital Charge Code |
2960495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$4,192.00 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.28
|
| Rate for Payer: Aetna Managed Medicare |
$293.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$524.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$503.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.44
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$964.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.46
|
| Rate for Payer: Health EOS Commercial |
$932.72
|
| Rate for Payer: HFN Commercial |
$964.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$786.00
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: NAPHCARE Commercial |
$628.80
|
| Rate for Payer: Preferred Network Access Commercial |
$964.16
|
| Rate for Payer: Quartz Beloit One Network |
$513.52
|
| Rate for Payer: Quartz Commercial |
$681.20
|
| Rate for Payer: Quartz Medicare Advantage |
$628.80
|
| Rate for Payer: The Alliance Commercial |
$4,192.00
|
| Rate for Payer: WEA Trust Commercial |
$576.40
|
| Rate for Payer: WPS Commercial |
$776.25
|
|
|
zzzWOUND CLOSURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960510
|
|
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
|
|
|
zzzWOUND CLOSURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzWOUND REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960513
|
|
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
|
|
|
zzzWOUND REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzWOUND REPAIR, PRIMARY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960511
|
|
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
|
|
|
zzzWOUND REPAIR, PRIMARY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzWRIST MANIPULATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960223
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
zzzWRIST MANIPULATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960223
|
|
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
|
|
|
zzzzCLOSURE DEVICE MYNX 6F/7F MX6721**ACCESS CLOSURE
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.49 |
| Max. Negotiated Rate |
$2,668.92 |
| Rate for Payer: Aetna Commercial |
$2,610.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,494.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.53
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,668.92
|
| Rate for Payer: Health EOS Commercial |
$2,581.89
|
| Rate for Payer: HFN Commercial |
$2,668.92
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,668.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.49
|
| Rate for Payer: Quartz Commercial |
$1,740.60
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| Rate for Payer: WPS Commercial |
$2,148.77
|
|
|
zzzzCLOSURE DEVICE MYNX 6F/7F MX6721**ACCESS CLOSURE
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.28 |
| Max. Negotiated Rate |
$11,604.00 |
| Rate for Payer: Aetna Commercial |
$2,610.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,494.86
|
| Rate for Payer: Aetna Managed Medicare |
$812.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,885.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.53
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,668.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.40
|
| Rate for Payer: Health EOS Commercial |
$2,581.89
|
| Rate for Payer: HFN Commercial |
$2,668.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,175.75
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,668.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.49
|
| Rate for Payer: Quartz Commercial |
$1,885.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.60
|
| Rate for Payer: The Alliance Commercial |
$11,604.00
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| Rate for Payer: WPS Commercial |
$2,148.77
|
|
