|
zzzCLOSED REDUCTION WRIST FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959969
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCOLECTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2959937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
zzzCOLECTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2959937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
zzzCOLOSTOMY TAKEDOWN / HARTMEN REVERSAL
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2959942
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
zzzCOLOSTOMY TAKEDOWN / HARTMEN REVERSAL
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2959942
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
zzzCOMPARTMENT SYNDROME
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959945
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCOMPARTMENT SYNDROME
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959945
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCOMPOSITE FLAP
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCOMPOSITE FLAP
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCORPORAL IRRIGATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959953
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCORPORAL IRRIGATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959953
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCUTANEOUS FLAP
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzCUTANEOUS FLAP
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzDECORTICATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959993
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
zzzDECORTICATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959993
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ZZZ *** DO NOT ORDER *** KIT LITHOCLAST TRILOGY PROBE 3.9MM X 350MM & STONE CATCHER M0068403540 ***
|
Facility
|
IP
|
$6,666.00
|
|
| Hospital Charge Code |
5459833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,396.99 |
| Max. Negotiated Rate |
$6,378.03 |
| Rate for Payer: Aetna Commercial |
$6,239.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,962.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,674.30
|
| Rate for Payer: Cash Price |
$1,999.80
|
| Rate for Payer: Cigna Commercial |
$6,378.03
|
| Rate for Payer: Health EOS Commercial |
$6,170.05
|
| Rate for Payer: HFN Commercial |
$6,378.03
|
| Rate for Payer: Multiplan Commercial |
$5,546.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6,378.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,396.99
|
| Rate for Payer: Quartz Commercial |
$4,159.58
|
| Rate for Payer: WEA Trust Commercial |
$3,812.95
|
| Rate for Payer: WPS Commercial |
$5,134.82
|
|
|
ZZZ *** DO NOT ORDER *** KIT LITHOCLAST TRILOGY PROBE 3.9MM X 350MM & STONE CATCHER M0068403540 ***
|
Facility
|
OP
|
$6,666.00
|
|
| Hospital Charge Code |
5459833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,941.14 |
| Max. Negotiated Rate |
$6,378.03 |
| Rate for Payer: Aetna Commercial |
$6,239.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,962.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,941.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,506.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,466.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,327.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,674.30
|
| Rate for Payer: Cash Price |
$1,999.80
|
| Rate for Payer: Cigna Commercial |
$6,378.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,879.61
|
| Rate for Payer: Health EOS Commercial |
$6,170.05
|
| Rate for Payer: HFN Commercial |
$6,378.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,199.48
|
| Rate for Payer: Multiplan Commercial |
$5,546.11
|
| Rate for Payer: NAPHCARE Commercial |
$4,159.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,378.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,396.99
|
| Rate for Payer: Quartz Commercial |
$4,506.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,159.58
|
| Rate for Payer: The Alliance Commercial |
$3,466.32
|
| Rate for Payer: WEA Trust Commercial |
$3,812.95
|
| Rate for Payer: WPS Commercial |
$5,134.82
|
|
|
zzzEAR SURGERY
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
2960000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,366.07 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$2,897.23
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
zzzEAR SURGERY
|
Facility
|
OP
|
$4,643.00
|
|
| Hospital Charge Code |
2960000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,352.04 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,352.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,138.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,414.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,317.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,702.23
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,621.54
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,897.23
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$3,138.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,897.23
|
| Rate for Payer: The Alliance Commercial |
$2,414.36
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
zzzECTROPION REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzECTROPION REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzELBOW MANIPULATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
zzzELBOW MANIPULATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ZZZ***ESMARK BANDAGE 6X9 DYNJ05918 (SUB)*** DUPLICATE *** USE 3007080 ***
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
5810083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Aetna Managed Medicare |
$20.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.32
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.38
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: NAPHCARE Commercial |
$44.30
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: Quartz Medicare Advantage |
$44.30
|
| Rate for Payer: The Alliance Commercial |
$36.92
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
ZZZ***ESMARK BANDAGE 6X9 DYNJ05918 (SUB)*** DUPLICATE *** USE 3007080 ***
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
5810083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$44.30
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
