|
zzzPANNICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960303
|
|
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
|
|
|
zzzPANNICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960303
|
|
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
|
|
|
zzzPARATHYROIDECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960304
|
|
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
|
|
|
zzzPARATHYROIDECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960304
|
|
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
|
|
|
ZZZPATCH PRESS EYE****DISC 8/17
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2963002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
ZZZPATCH PRESS EYE****DISC 8/17
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2963002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
zzzPEDICLED FLAP
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960076
|
|
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
|
|
|
zzzPEDICLED FLAP
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960076
|
|
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
|
|
|
zzzPEG 24 FR ENDOVIVE PULL 6648zzz
|
Facility
|
OP
|
$1,711.00
|
|
| Hospital Charge Code |
2973104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.24 |
| Max. Negotiated Rate |
$1,637.08 |
| Rate for Payer: Aetna Commercial |
$1,601.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,530.32
|
| Rate for Payer: Aetna Managed Medicare |
$498.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,156.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$889.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.10
|
| Rate for Payer: Cash Price |
$513.30
|
| Rate for Payer: Cigna Commercial |
$1,637.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$995.80
|
| Rate for Payer: Health EOS Commercial |
$1,583.70
|
| Rate for Payer: HFN Commercial |
$1,637.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,334.58
|
| Rate for Payer: Multiplan Commercial |
$1,423.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,067.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,637.08
|
| Rate for Payer: Quartz Beloit One Network |
$871.93
|
| Rate for Payer: Quartz Commercial |
$1,156.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,067.66
|
| Rate for Payer: The Alliance Commercial |
$889.72
|
| Rate for Payer: WEA Trust Commercial |
$978.69
|
| Rate for Payer: WPS Commercial |
$1,317.98
|
|
|
zzzPEG 24 FR ENDOVIVE PULL 6648zzz
|
Facility
|
IP
|
$1,711.00
|
|
| Hospital Charge Code |
2973104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.93 |
| Max. Negotiated Rate |
$1,637.08 |
| Rate for Payer: Aetna Commercial |
$1,601.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,530.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.10
|
| Rate for Payer: Cash Price |
$513.30
|
| Rate for Payer: Cigna Commercial |
$1,637.08
|
| Rate for Payer: Health EOS Commercial |
$1,583.70
|
| Rate for Payer: HFN Commercial |
$1,637.08
|
| Rate for Payer: Multiplan Commercial |
$1,423.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,637.08
|
| Rate for Payer: Quartz Beloit One Network |
$871.93
|
| Rate for Payer: Quartz Commercial |
$1,067.66
|
| Rate for Payer: WEA Trust Commercial |
$978.69
|
| Rate for Payer: WPS Commercial |
$1,317.98
|
|
|
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 |
$450.20 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Aetna Managed Medicare |
$450.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$803.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.77
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,205.88
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: NAPHCARE Commercial |
$964.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$1,045.10
|
| Rate for Payer: Quartz Medicare Advantage |
$964.70
|
| Rate for Payer: The Alliance Commercial |
$803.92
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
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 |
$787.84 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$964.70
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
zzzPENILE CORPUS CAVERNOSUM REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960536
|
|
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
|
|
|
zzzPENILE CORPUS CAVERNOSUM REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960536
|
|
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
|
|
|
zzzPENILE PROSTHESIS
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960325
|
|
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
|
|
|
zzzPENILE PROSTHESIS
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960325
|
|
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
|
|
|
zzzPERIORBITAL SURGERY
|
Facility
|
OP
|
$4,438.00
|
|
| Hospital Charge Code |
2960314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,292.35 |
| Max. Negotiated Rate |
$4,246.28 |
| Rate for Payer: Aetna Commercial |
$4,153.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,969.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,292.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,000.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,307.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,215.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,446.23
|
| Rate for Payer: Cash Price |
$1,331.40
|
| Rate for Payer: Cigna Commercial |
$4,246.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,582.92
|
| Rate for Payer: Health EOS Commercial |
$4,107.81
|
| Rate for Payer: HFN Commercial |
$4,246.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,461.64
|
| Rate for Payer: Multiplan Commercial |
$3,692.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,769.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,246.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,261.60
|
| Rate for Payer: Quartz Commercial |
$3,000.09
|
| Rate for Payer: Quartz Medicare Advantage |
$2,769.31
|
| Rate for Payer: The Alliance Commercial |
$2,307.76
|
| Rate for Payer: WEA Trust Commercial |
$2,538.54
|
| Rate for Payer: WPS Commercial |
$3,418.59
|
|
|
zzzPERIORBITAL SURGERY
|
Facility
|
IP
|
$4,438.00
|
|
| Hospital Charge Code |
2960314
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,261.60 |
| Max. Negotiated Rate |
$4,246.28 |
| Rate for Payer: Aetna Commercial |
$4,153.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,969.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,446.23
|
| Rate for Payer: Cash Price |
$1,331.40
|
| Rate for Payer: Cigna Commercial |
$4,246.28
|
| Rate for Payer: Health EOS Commercial |
$4,107.81
|
| Rate for Payer: HFN Commercial |
$4,246.28
|
| Rate for Payer: Multiplan Commercial |
$3,692.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,246.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,261.60
|
| Rate for Payer: Quartz Commercial |
$2,769.31
|
| Rate for Payer: WEA Trust Commercial |
$2,538.54
|
| Rate for Payer: WPS Commercial |
$3,418.59
|
|
|
zzzPOSTERIOR REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960318
|
|
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
|
|
|
zzzPOSTERIOR REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960318
|
|
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***PROCEDURE KIT TRUCLEAR HYSTEROSCOPIC 7209827*** DISC ***
|
Facility
|
IP
|
$3,897.00
|
|
| Hospital Charge Code |
5074634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,985.91 |
| Max. Negotiated Rate |
$3,728.65 |
| Rate for Payer: Aetna Commercial |
$3,647.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,485.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,148.03
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,728.65
|
| Rate for Payer: Health EOS Commercial |
$3,607.06
|
| Rate for Payer: HFN Commercial |
$3,728.65
|
| Rate for Payer: Multiplan Commercial |
$3,242.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,728.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,985.91
|
| Rate for Payer: Quartz Commercial |
$2,431.73
|
| Rate for Payer: WEA Trust Commercial |
$2,229.08
|
| Rate for Payer: WPS Commercial |
$3,001.86
|
|
|
ZZZ***PROCEDURE KIT TRUCLEAR HYSTEROSCOPIC 7209827*** DISC ***
|
Facility
|
OP
|
$3,897.00
|
|
| Hospital Charge Code |
5074634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,134.81 |
| Max. Negotiated Rate |
$3,728.65 |
| Rate for Payer: Aetna Commercial |
$3,647.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,485.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,134.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,634.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,026.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,945.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,148.03
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna Commercial |
$3,728.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,268.05
|
| Rate for Payer: Health EOS Commercial |
$3,607.06
|
| Rate for Payer: HFN Commercial |
$3,728.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,039.66
|
| Rate for Payer: Multiplan Commercial |
$3,242.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,431.73
|
| Rate for Payer: Preferred Network Access Commercial |
$3,728.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,985.91
|
| Rate for Payer: Quartz Commercial |
$2,634.37
|
| Rate for Payer: Quartz Medicare Advantage |
$2,431.73
|
| Rate for Payer: The Alliance Commercial |
$2,026.44
|
| Rate for Payer: WEA Trust Commercial |
$2,229.08
|
| Rate for Payer: WPS Commercial |
$3,001.86
|
|
|
zzzRAMSTEDT PROCEDURE
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960337
|
|
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
|
|
|
zzzRAMSTEDT PROCEDURE
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960337
|
|
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
|
|
|
zzzRECTAL PROLAPSE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960340
|
|
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
|
|
