|
zzzLAPAROSCOPIC GASTRIC BANDING
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,420.94 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC GASTRIC BANDING
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.83 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,537.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,490.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,906.97
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,236.14
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,188.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,537.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,188.91
|
| Rate for Payer: The Alliance Commercial |
$3,490.76
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC NISSEN FUNDOPLICATION
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960182
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.83 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,537.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,490.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,906.97
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,236.14
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,188.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,537.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,188.91
|
| Rate for Payer: The Alliance Commercial |
$3,490.76
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC NISSEN FUNDOPLICATION
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960182
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,420.94 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC RENAL CYSTECTOMY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
4494604
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,420.94 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC RENAL CYSTECTOMY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
4494604
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.83 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,537.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,490.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,906.97
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,236.14
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,188.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,537.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,188.91
|
| Rate for Payer: The Alliance Commercial |
$3,490.76
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC SALPINGO OOPHORECTOMY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.83 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,537.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,490.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,906.97
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,236.14
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,188.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,537.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,188.91
|
| Rate for Payer: The Alliance Commercial |
$3,490.76
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLAPAROSCOPIC SALPINGO OOPHORECTOMY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,420.94 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
zzzLASER ABLATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960190
|
|
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
|
|
|
zzzLASER ABLATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960190
|
|
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
|
|
|
zzzLEG FASCIOTOMY, UPPER
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960056
|
|
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
|
|
|
zzzLEG FASCIOTOMY, UPPER
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960056
|
|
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
|
|
|
zzzLESION, EXCISION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960027
|
|
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
|
|
|
zzzLESION, EXCISION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960027
|
|
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
|
|
|
ZZZ *** LIGASURE 5MM LAPAROSCOPIC BLUNT TIP SEALER LF1637 *** DISC ITEM***
|
Facility
|
OP
|
$5,592.00
|
|
| Hospital Charge Code |
2965539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,628.39 |
| Max. Negotiated Rate |
$5,350.43 |
| Rate for Payer: Aetna Commercial |
$5,234.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,001.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,628.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,780.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,907.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,791.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,082.31
|
| Rate for Payer: Cash Price |
$1,677.60
|
| Rate for Payer: Cigna Commercial |
$5,350.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,254.54
|
| Rate for Payer: Health EOS Commercial |
$5,175.96
|
| Rate for Payer: HFN Commercial |
$5,350.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,361.76
|
| Rate for Payer: Multiplan Commercial |
$4,652.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,489.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,350.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,849.68
|
| Rate for Payer: Quartz Commercial |
$3,780.19
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.41
|
| Rate for Payer: The Alliance Commercial |
$2,907.84
|
| Rate for Payer: WEA Trust Commercial |
$3,198.62
|
| Rate for Payer: WPS Commercial |
$4,307.52
|
|
|
ZZZ *** LIGASURE 5MM LAPAROSCOPIC BLUNT TIP SEALER LF1637 *** DISC ITEM***
|
Facility
|
IP
|
$5,592.00
|
|
| Hospital Charge Code |
2965539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,849.68 |
| Max. Negotiated Rate |
$5,350.43 |
| Rate for Payer: Aetna Commercial |
$5,234.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,001.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,082.31
|
| Rate for Payer: Cash Price |
$1,677.60
|
| Rate for Payer: Cigna Commercial |
$5,350.43
|
| Rate for Payer: Health EOS Commercial |
$5,175.96
|
| Rate for Payer: HFN Commercial |
$5,350.43
|
| Rate for Payer: Multiplan Commercial |
$4,652.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,350.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,849.68
|
| Rate for Payer: Quartz Commercial |
$3,489.41
|
| Rate for Payer: WEA Trust Commercial |
$3,198.62
|
| Rate for Payer: WPS Commercial |
$4,307.52
|
|
|
zzzLIP WEDGE RESECTION, LOWER
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2950502
|
|
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
|
|
|
zzzLIP WEDGE RESECTION, LOWER
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2950502
|
|
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
|
|
|
zzzLOW ANTERIOR RESECTION
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960209
|
|
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
|
|
|
zzzLOW ANTERIOR RESECTION
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960209
|
|
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
|
|
|
zzzLUNG PLICATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960213
|
|
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
|
|
|
zzzLUNG PLICATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960213
|
|
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
|
|
|
zzzLUNG WEDGE RESECTION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950485
|
|
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
|
|
|
zzzLUNG WEDGE RESECTION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950485
|
|
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
|
|
|
zzzLYMPHADENECTOMY
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2960214
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,151.39 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,841.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.82
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,762.64
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,994.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.11
|
| Rate for Payer: The Alliance Commercial |
$3,841.76
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
