|
zzzINCISION AND DRAINAGE, KNEE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960140
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, THIGH
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960142
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, THIGH
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960142
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, TOE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960143
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, TOE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960143
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, WRIST
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960144
|
|
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
|
|
|
zzzINCISION AND DRAINAGE, WRIST
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960144
|
|
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
|
|
|
zzzINSERTION DRAIN
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960156
|
|
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
|
|
|
zzzINSERTION DRAIN
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960156
|
|
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
|
|
|
zzzINTERTROCHANTERIC TITANIUM FEMORAL NAILING, REMOVAL
|
Facility
|
OP
|
$5,427.00
|
|
| Hospital Charge Code |
2960429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,580.34 |
| Max. Negotiated Rate |
$5,192.55 |
| Rate for Payer: Aetna Commercial |
$5,079.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,853.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,580.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,668.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,822.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,709.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,991.36
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cigna Commercial |
$5,192.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,158.51
|
| Rate for Payer: Health EOS Commercial |
$5,023.23
|
| Rate for Payer: HFN Commercial |
$5,192.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,233.06
|
| Rate for Payer: Multiplan Commercial |
$4,515.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,386.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,192.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,765.60
|
| Rate for Payer: Quartz Commercial |
$3,668.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,386.45
|
| Rate for Payer: The Alliance Commercial |
$2,822.04
|
| Rate for Payer: WEA Trust Commercial |
$3,104.24
|
| Rate for Payer: WPS Commercial |
$4,180.42
|
|
|
zzzINTERTROCHANTERIC TITANIUM FEMORAL NAILING, REMOVAL
|
Facility
|
IP
|
$5,427.00
|
|
| Hospital Charge Code |
2960429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,765.60 |
| Max. Negotiated Rate |
$5,192.55 |
| Rate for Payer: Aetna Commercial |
$5,079.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,853.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,991.36
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cigna Commercial |
$5,192.55
|
| Rate for Payer: Health EOS Commercial |
$5,023.23
|
| Rate for Payer: HFN Commercial |
$5,192.55
|
| Rate for Payer: Multiplan Commercial |
$4,515.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,192.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,765.60
|
| Rate for Payer: Quartz Commercial |
$3,386.45
|
| Rate for Payer: WEA Trust Commercial |
$3,104.24
|
| Rate for Payer: WPS Commercial |
$4,180.42
|
|
|
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 |
$3,446.35 |
| Max. Negotiated Rate |
$11,323.73 |
| Rate for Payer: Aetna Commercial |
$11,077.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,585.22
|
| Rate for Payer: Aetna Managed Medicare |
$3,446.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,000.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,154.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,908.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,523.45
|
| Rate for Payer: Cash Price |
$3,550.50
|
| Rate for Payer: Cigna Commercial |
$11,323.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,887.97
|
| Rate for Payer: Health EOS Commercial |
$10,954.48
|
| Rate for Payer: HFN Commercial |
$11,323.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,231.30
|
| Rate for Payer: Multiplan Commercial |
$9,846.72
|
| Rate for Payer: NAPHCARE Commercial |
$7,385.04
|
| Rate for Payer: Preferred Network Access Commercial |
$11,323.73
|
| Rate for Payer: Quartz Beloit One Network |
$6,031.12
|
| Rate for Payer: Quartz Commercial |
$8,000.46
|
| Rate for Payer: Quartz Medicare Advantage |
$7,385.04
|
| Rate for Payer: The Alliance Commercial |
$6,154.20
|
| Rate for Payer: WEA Trust Commercial |
$6,769.62
|
| Rate for Payer: WPS Commercial |
$9,116.50
|
|
|
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 |
$6,031.12 |
| Max. Negotiated Rate |
$11,323.73 |
| Rate for Payer: Aetna Commercial |
$11,077.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,585.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,523.45
|
| Rate for Payer: Cash Price |
$3,550.50
|
| Rate for Payer: Cigna Commercial |
$11,323.73
|
| Rate for Payer: Health EOS Commercial |
$10,954.48
|
| Rate for Payer: HFN Commercial |
$11,323.73
|
| Rate for Payer: Multiplan Commercial |
$9,846.72
|
| Rate for Payer: Preferred Network Access Commercial |
$11,323.73
|
| Rate for Payer: Quartz Beloit One Network |
$6,031.12
|
| Rate for Payer: Quartz Commercial |
$7,385.04
|
| Rate for Payer: WEA Trust Commercial |
$6,769.62
|
| Rate for Payer: WPS Commercial |
$9,116.50
|
|
|
zzzJEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960161
|
|
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
|
|
|
zzzJEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960161
|
|
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
|
|
|
zzzKNEE ARTHRODESIS
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
zzzKNEE ARTHRODESIS
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
zzzKNEE OSTEOTOMY
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
zzzKNEE OSTEOTOMY
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
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 |
$889.03 |
| Max. Negotiated Rate |
$2,921.11 |
| Rate for Payer: Aetna Commercial |
$2,857.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,730.60
|
| Rate for Payer: Aetna Managed Medicare |
$889.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,063.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,587.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,524.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,682.81
|
| Rate for Payer: Cash Price |
$915.90
|
| Rate for Payer: Cigna Commercial |
$2,921.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,776.85
|
| Rate for Payer: Health EOS Commercial |
$2,825.86
|
| Rate for Payer: HFN Commercial |
$2,921.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,381.34
|
| Rate for Payer: Multiplan Commercial |
$2,540.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,905.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,921.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.81
|
| Rate for Payer: Quartz Commercial |
$2,063.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,905.07
|
| Rate for Payer: The Alliance Commercial |
$1,587.56
|
| Rate for Payer: WEA Trust Commercial |
$1,746.32
|
| Rate for Payer: WPS Commercial |
$2,351.73
|
|
|
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 |
$1,555.81 |
| Max. Negotiated Rate |
$2,921.11 |
| Rate for Payer: Aetna Commercial |
$2,857.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,730.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,682.81
|
| Rate for Payer: Cash Price |
$915.90
|
| Rate for Payer: Cigna Commercial |
$2,921.11
|
| Rate for Payer: Health EOS Commercial |
$2,825.86
|
| Rate for Payer: HFN Commercial |
$2,921.11
|
| Rate for Payer: Multiplan Commercial |
$2,540.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,921.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.81
|
| Rate for Payer: Quartz Commercial |
$1,905.07
|
| Rate for Payer: WEA Trust Commercial |
$1,746.32
|
| Rate for Payer: WPS Commercial |
$2,351.73
|
|
|
zzzLACRIMAL DUCT PROBING
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960168
|
|
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
|
|
|
zzzLACRIMAL DUCT PROBING
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960168
|
|
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
|
|
|
zzzLACRIMAL LACERATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960169
|
|
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
|
|
|
zzzLACRIMAL LACERATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960169
|
|
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
|
|
