|
zzzPEDICLED FLAP
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960076
|
|
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
|
|
|
zzzPEDICLED FLAP
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960076
|
|
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
|
|
|
zzzPEG 24 FR ENDOVIVE PULL 6648zzz
|
Facility
OP
|
$1,711.00
|
|
| Hospital Charge Code |
2973104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.08 |
| Max. Negotiated Rate |
$6,844.00 |
| Rate for Payer: Aetna Commercial |
$1,539.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,471.46
|
| Rate for Payer: Aetna Managed Medicare |
$479.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,112.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$855.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$821.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.83
|
| Rate for Payer: Cash Price |
$513.30
|
| Rate for Payer: Cigna Commercial |
$1,574.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$957.48
|
| Rate for Payer: Health EOS Commercial |
$1,522.79
|
| Rate for Payer: HFN Commercial |
$1,574.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,283.25
|
| Rate for Payer: Multiplan Commercial |
$1,368.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,026.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,574.12
|
| Rate for Payer: Quartz Beloit One Network |
$838.39
|
| Rate for Payer: Quartz Commercial |
$1,112.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,026.60
|
| Rate for Payer: The Alliance Commercial |
$6,844.00
|
| Rate for Payer: WEA Trust Commercial |
$941.05
|
| Rate for Payer: WPS Commercial |
$1,267.34
|
|
|
zzzPEG 24 FR ENDOVIVE PULL 6648zzz
|
Facility
IP
|
$1,711.00
|
|
| Hospital Charge Code |
2973104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.39 |
| Max. Negotiated Rate |
$1,574.12 |
| Rate for Payer: Aetna Commercial |
$1,539.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.83
|
| Rate for Payer: Cash Price |
$513.30
|
| Rate for Payer: Cigna Commercial |
$1,574.12
|
| Rate for Payer: Health EOS Commercial |
$1,522.79
|
| Rate for Payer: HFN Commercial |
$1,574.12
|
| Rate for Payer: Multiplan Commercial |
$1,368.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,026.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,574.12
|
| Rate for Payer: Quartz Beloit One Network |
$838.39
|
| Rate for Payer: Quartz Commercial |
$1,026.60
|
| Rate for Payer: WEA Trust Commercial |
$941.05
|
| Rate for Payer: WPS Commercial |
$1,267.34
|
|
|
zzzPEG TUBE PUSH 24FR M00566491zzz
|
Facility
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5459517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.88 |
| Max. Negotiated Rate |
$6,184.00 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Aetna Managed Medicare |
$432.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$773.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$742.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$865.14
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| Rate for Payer: Quartz Medicare Advantage |
$927.60
|
| Rate for Payer: The Alliance Commercial |
$6,184.00
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
zzzPEG TUBE PUSH 24FR M00566491zzz
|
Facility
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5459517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$927.60
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
zzzPENILE CORPUS CAVERNOSUM REPAIR
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960536
|
|
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
|
|
|
zzzPENILE CORPUS CAVERNOSUM REPAIR
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960536
|
|
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
|
|
|
zzzPENILE PROSTHESIS
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960325
|
|
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
|
|
|
zzzPENILE PROSTHESIS
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960325
|
|
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
|
|
|
zzzPERIORBITAL SURGERY
|
Facility
IP
|
$4,438.00
|
|
| Hospital Charge Code |
2960314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,174.62 |
| Max. Negotiated Rate |
$4,082.96 |
| Rate for Payer: Aetna Commercial |
$3,994.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,352.14
|
| Rate for Payer: Cash Price |
$1,331.40
|
| Rate for Payer: Cigna Commercial |
$4,082.96
|
| Rate for Payer: Health EOS Commercial |
$3,949.82
|
| Rate for Payer: HFN Commercial |
$4,082.96
|
| Rate for Payer: Multiplan Commercial |
$3,550.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,662.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,082.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,174.62
|
| Rate for Payer: Quartz Commercial |
$2,662.80
|
| Rate for Payer: WEA Trust Commercial |
$2,440.90
|
| Rate for Payer: WPS Commercial |
$3,287.23
|
|
|
zzzPERIORBITAL SURGERY
|
Facility
OP
|
$4,438.00
|
|
| Hospital Charge Code |
2960314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,242.64 |
| Max. Negotiated Rate |
$17,752.00 |
| Rate for Payer: Aetna Commercial |
$3,994.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,816.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,242.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,884.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,219.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,130.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,352.14
|
| Rate for Payer: Cash Price |
$1,331.40
|
| Rate for Payer: Cigna Commercial |
$4,082.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,483.50
|
| Rate for Payer: Health EOS Commercial |
$3,949.82
|
| Rate for Payer: HFN Commercial |
$4,082.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,328.50
|
| Rate for Payer: Multiplan Commercial |
$3,550.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,662.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,082.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,174.62
|
| Rate for Payer: Quartz Commercial |
$2,884.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,662.80
|
| Rate for Payer: The Alliance Commercial |
$17,752.00
|
| Rate for Payer: WEA Trust Commercial |
$2,440.90
|
| Rate for Payer: WPS Commercial |
$3,287.23
|
|
|
zzzPOSTERIOR REPAIR
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960318
|
|
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
|
|
|
zzzPOSTERIOR REPAIR
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960318
|
|
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
|
|
|
ZZZ***PROCEDURE KIT TRUCLEAR HYSTEROSCOPIC 7209827*** DISC ***
|
Facility
IP
|
$3,897.00
|
|
| Hospital Charge Code |
5074634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,909.53 |
| Max. Negotiated Rate |
$3,585.24 |
| Rate for Payer: Aetna Commercial |
$3,507.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,065.41
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,585.24
|
| Rate for Payer: Health EOS Commercial |
$3,468.33
|
| Rate for Payer: HFN Commercial |
$3,585.24
|
| Rate for Payer: Multiplan Commercial |
$3,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,338.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,585.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,909.53
|
| Rate for Payer: Quartz Commercial |
$2,338.20
|
| Rate for Payer: WEA Trust Commercial |
$2,143.35
|
| Rate for Payer: WPS Commercial |
$2,886.51
|
|
|
ZZZ***PROCEDURE KIT TRUCLEAR HYSTEROSCOPIC 7209827*** DISC ***
|
Facility
OP
|
$3,897.00
|
|
| Hospital Charge Code |
5074634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,091.16 |
| Max. Negotiated Rate |
$15,588.00 |
| Rate for Payer: Aetna Commercial |
$3,507.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,351.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,091.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,533.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,948.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,870.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,065.41
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,585.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,180.76
|
| Rate for Payer: Health EOS Commercial |
$3,468.33
|
| Rate for Payer: HFN Commercial |
$3,585.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,922.75
|
| Rate for Payer: Multiplan Commercial |
$3,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,338.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,585.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,909.53
|
| Rate for Payer: Quartz Commercial |
$2,533.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,338.20
|
| Rate for Payer: The Alliance Commercial |
$15,588.00
|
| Rate for Payer: WEA Trust Commercial |
$2,143.35
|
| Rate for Payer: WPS Commercial |
$2,886.51
|
|
|
zzzRAMSTEDT PROCEDURE
|
Facility
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960337
|
|
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
|
|
|
zzzRAMSTEDT PROCEDURE
|
Facility
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960337
|
|
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
|
|
|
zzzRECTAL PROLAPSE
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960340
|
|
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
|
|
|
zzzRECTAL PROLAPSE
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960340
|
|
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
|
|
|
zzzRECTOCELE REPAIR
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960341
|
|
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
|
|
|
zzzRECTOCELE REPAIR
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960341
|
|
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
|
|
|
zzzRETINAL REATTACHMENT, INTRAOCULAR GAS
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960350
|
|
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
|
|
|
zzzRETINAL REATTACHMENT, INTRAOCULAR GAS
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960350
|
|
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
|
|
|
zzzRHYTIDECTOMY
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960355
|
|
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
|
|
