|
zzHerpes Simplex Virus Type I & II IgM w/ Reflex (Obsolete)
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
977975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$208.21
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
zzKNEE MANIPULATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960221
|
|
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
|
|
|
zzKNEE MANIPULATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960221
|
|
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
|
|
|
zzOcc Bld Stl, 3 Cards
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
979905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$206.49 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$4.40
|
| Rate for Payer: Anthem Medicare Advantage |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.40
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$206.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.40
|
| Rate for Payer: Health EOS Commercial |
$197.80
|
| Rate for Payer: HFN Commercial |
$206.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$206.49
|
| Rate for Payer: Quartz Beloit One Network |
$95.64
|
| Rate for Payer: Quartz Commercial |
$123.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4.40
|
| Rate for Payer: The Alliance Commercial |
$17.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.40
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$19.36
|
|
|
zzOcc Bld Stl, 3 Cards
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
979905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.51 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
zzOcc Bld Stl, 3 Cards
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
979905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.30
|
| Rate for Payer: Anthem Medicare Advantage |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.40
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.40
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$141.28
|
| Rate for Payer: Quartz Medicare Advantage |
$4.40
|
| Rate for Payer: The Alliance Commercial |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.40
|
| Rate for Payer: United Healthcare PPO |
$163.02
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: Wellcare Medicare |
$4.40
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
zz.Oligoclonal Bands CSF
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
1114847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$328.18 |
| Rate for Payer: Aetna Commercial |
$321.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.78
|
| Rate for Payer: Aetna Managed Medicare |
$28.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.29
|
| Rate for Payer: Anthem Medicare Advantage |
$28.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.49
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$328.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.49
|
| Rate for Payer: Health EOS Commercial |
$317.48
|
| Rate for Payer: HFN Commercial |
$328.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.49
|
| Rate for Payer: Multiplan Commercial |
$285.38
|
| Rate for Payer: NAPHCARE Commercial |
$42.73
|
| Rate for Payer: Preferred Network Access Commercial |
$328.18
|
| Rate for Payer: Quartz Beloit One Network |
$174.79
|
| Rate for Payer: Quartz Commercial |
$231.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.49
|
| Rate for Payer: The Alliance Commercial |
$113.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.49
|
| Rate for Payer: United Healthcare PPO |
$267.54
|
| Rate for Payer: WEA Trust Commercial |
$196.20
|
| Rate for Payer: Wellcare Medicare |
$28.49
|
| Rate for Payer: WPS Commercial |
$264.21
|
|
|
zz.Oligoclonal Bands CSF
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
1114847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.79 |
| Max. Negotiated Rate |
$328.18 |
| Rate for Payer: Aetna Commercial |
$321.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.06
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$328.18
|
| Rate for Payer: Health EOS Commercial |
$317.48
|
| Rate for Payer: HFN Commercial |
$328.18
|
| Rate for Payer: Multiplan Commercial |
$285.38
|
| Rate for Payer: Preferred Network Access Commercial |
$328.18
|
| Rate for Payer: Quartz Beloit One Network |
$174.79
|
| Rate for Payer: Quartz Commercial |
$214.03
|
| Rate for Payer: WEA Trust Commercial |
$196.20
|
| Rate for Payer: WPS Commercial |
$264.21
|
|
|
zzPOLYSOMNOGRAPHY W/CPAP 9581126
|
Professional
|
Both
|
$2,484.00
|
|
|
Service Code
|
CPT 95811 26
|
| Hospital Charge Code |
3015465
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.69 |
| Max. Negotiated Rate |
$2,454.19 |
| Rate for Payer: Aetna Commercial |
$2,454.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,221.69
|
| Rate for Payer: Aetna Managed Medicare |
$124.69
|
| Rate for Payer: Anthem Medicare Advantage |
$124.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.69
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$2,454.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.69
|
| Rate for Payer: Health EOS Commercial |
$2,350.86
|
| Rate for Payer: HFN Commercial |
$2,454.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$447.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.69
|
| Rate for Payer: Multiplan Commercial |
$2,066.69
|
| Rate for Payer: NAPHCARE Commercial |
$187.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,454.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.68
|
| Rate for Payer: Quartz Commercial |
$1,472.52
|
| Rate for Payer: Quartz Medicare Advantage |
$124.69
|
| Rate for Payer: The Alliance Commercial |
$311.71
|
| Rate for Payer: United Healthcare Medicaid |
$129.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.69
|
| Rate for Payer: WEA Trust Commercial |
$1,420.85
|
| Rate for Payer: WPS Commercial |
$498.74
|
|
|
zzzABDOMINAL AORTIC ANEURYSM, ENDOVASCULAR REPAIR
|
Facility
|
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2960017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,679.29 |
| Max. Negotiated Rate |
$15,374.82 |
| Rate for Payer: Aetna Commercial |
$15,040.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,372.11
|
| Rate for Payer: Aetna Managed Medicare |
$4,679.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,862.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,355.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,021.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,857.23
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$15,374.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,352.16
|
| Rate for Payer: Health EOS Commercial |
$14,873.47
|
| Rate for Payer: HFN Commercial |
$15,374.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,533.82
|
| Rate for Payer: Multiplan Commercial |
$13,369.41
|
| Rate for Payer: NAPHCARE Commercial |
$10,027.06
|
| Rate for Payer: Preferred Network Access Commercial |
$15,374.82
|
| Rate for Payer: Quartz Beloit One Network |
$8,188.76
|
| Rate for Payer: Quartz Commercial |
$10,862.64
|
| Rate for Payer: Quartz Medicare Advantage |
$10,027.06
|
| Rate for Payer: The Alliance Commercial |
$8,355.88
|
| Rate for Payer: WEA Trust Commercial |
$9,191.47
|
| Rate for Payer: WPS Commercial |
$12,377.95
|
|
|
zzzABDOMINAL AORTIC ANEURYSM, ENDOVASCULAR REPAIR
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2960017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,188.76 |
| Max. Negotiated Rate |
$15,374.82 |
| Rate for Payer: Aetna Commercial |
$15,040.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,372.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,857.23
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$15,374.82
|
| Rate for Payer: Health EOS Commercial |
$14,873.47
|
| Rate for Payer: HFN Commercial |
$15,374.82
|
| Rate for Payer: Multiplan Commercial |
$13,369.41
|
| Rate for Payer: Preferred Network Access Commercial |
$15,374.82
|
| Rate for Payer: Quartz Beloit One Network |
$8,188.76
|
| Rate for Payer: Quartz Commercial |
$10,027.06
|
| Rate for Payer: WEA Trust Commercial |
$9,191.47
|
| Rate for Payer: WPS Commercial |
$12,377.95
|
|
|
zzzABDOMINAL HYSTERECTOMY W/ BILATERAL SALPINGO OOPHERECTOMY, TOTAL
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960518
|
|
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
|
|
|
zzzABDOMINAL HYSTERECTOMY W/ BILATERAL SALPINGO OOPHERECTOMY, TOTAL
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960518
|
|
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
|
|
|
zzzAMPUTATION, ANKLE
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,018.37
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, ANKLE
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.24 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$475.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.82
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.96
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,103.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.37
|
| Rate for Payer: The Alliance Commercial |
$848.64
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, FOREARM
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,018.37
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, FOREARM
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.24 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$475.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.82
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.96
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,103.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.37
|
| Rate for Payer: The Alliance Commercial |
$848.64
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, HAND
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.24 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$475.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.82
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.96
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,103.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.37
|
| Rate for Payer: The Alliance Commercial |
$848.64
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, HAND
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,018.37
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, HUMERUS
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
zzzAMPUTATION, HUMERUS
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
zzzAMPUTATION, SYME
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959797
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.24 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$475.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.82
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.96
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,103.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.37
|
| Rate for Payer: The Alliance Commercial |
$848.64
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, SYME
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959797
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,018.37
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, TOE
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959798
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.24 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$475.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.82
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.96
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,103.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.37
|
| Rate for Payer: The Alliance Commercial |
$848.64
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
zzzAMPUTATION, TOE
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959798
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,018.37
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
