|
zzzBLEB RESECTION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959850
|
|
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
|
|
|
zzzBLEPHARPTOSIS
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959852
|
|
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
|
|
|
zzzBLEPHARPTOSIS
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959852
|
|
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
|
|
|
zzzBRACHIAL PLEXUS SURGERY
|
Facility
|
IP
|
$12,095.00
|
|
| Hospital Charge Code |
2959872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,163.61 |
| Max. Negotiated Rate |
$11,572.50 |
| Rate for Payer: Aetna Commercial |
$11,320.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,817.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,666.76
|
| Rate for Payer: Cash Price |
$3,628.50
|
| Rate for Payer: Cigna Commercial |
$11,572.50
|
| Rate for Payer: Health EOS Commercial |
$11,195.13
|
| Rate for Payer: HFN Commercial |
$11,572.50
|
| Rate for Payer: Multiplan Commercial |
$10,063.04
|
| Rate for Payer: Preferred Network Access Commercial |
$11,572.50
|
| Rate for Payer: Quartz Beloit One Network |
$6,163.61
|
| Rate for Payer: Quartz Commercial |
$7,547.28
|
| Rate for Payer: WEA Trust Commercial |
$6,918.34
|
| Rate for Payer: WPS Commercial |
$9,316.78
|
|
|
zzzBRACHIAL PLEXUS SURGERY
|
Facility
|
OP
|
$12,095.00
|
|
| Hospital Charge Code |
2959872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,522.06 |
| Max. Negotiated Rate |
$11,572.50 |
| Rate for Payer: Aetna Commercial |
$11,320.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,817.77
|
| Rate for Payer: Aetna Managed Medicare |
$3,522.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,176.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,289.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,037.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,666.76
|
| Rate for Payer: Cash Price |
$3,628.50
|
| Rate for Payer: Cigna Commercial |
$11,572.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,039.29
|
| Rate for Payer: Health EOS Commercial |
$11,195.13
|
| Rate for Payer: HFN Commercial |
$11,572.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,434.10
|
| Rate for Payer: Multiplan Commercial |
$10,063.04
|
| Rate for Payer: NAPHCARE Commercial |
$7,547.28
|
| Rate for Payer: Preferred Network Access Commercial |
$11,572.50
|
| Rate for Payer: Quartz Beloit One Network |
$6,163.61
|
| Rate for Payer: Quartz Commercial |
$8,176.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7,547.28
|
| Rate for Payer: The Alliance Commercial |
$6,289.40
|
| Rate for Payer: WEA Trust Commercial |
$6,918.34
|
| Rate for Payer: WPS Commercial |
$9,316.78
|
|
|
zzzBREAST RECONSTRUCTION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959879
|
|
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
|
|
|
zzzBREAST RECONSTRUCTION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959879
|
|
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
|
|
|
zzzBUNIONECTOMY, KELLER
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2950494
|
|
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
|
|
|
zzzBUNIONECTOMY, KELLER
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2950494
|
|
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
|
|
|
zzzBUNIONECTOMY, TAYLOR
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2950493
|
|
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
|
|
|
zzzBUNIONECTOMY, TAYLOR
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2950493
|
|
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
|
|
|
ZZZ***CABLE/CRIMP CABLE - READY 1.8MM X 25 2232-04-18***DO NOT USE ON PREF CARD***ZZZ"
|
Facility
|
IP
|
$4,590.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2967453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.06 |
| Max. Negotiated Rate |
$4,391.71 |
| Rate for Payer: Aetna Commercial |
$4,296.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,105.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,530.01
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$4,391.71
|
| Rate for Payer: Health EOS Commercial |
$4,248.50
|
| Rate for Payer: HFN Commercial |
$4,391.71
|
| Rate for Payer: Multiplan Commercial |
$3,818.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,391.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,339.06
|
| Rate for Payer: Quartz Commercial |
$2,864.16
|
| Rate for Payer: WEA Trust Commercial |
$2,625.48
|
| Rate for Payer: WPS Commercial |
$3,535.68
|
|
|
ZZZ***CABLE/CRIMP CABLE - READY 1.8MM X 25 2232-04-18***DO NOT USE ON PREF CARD***ZZZ"
|
Facility
|
OP
|
$4,590.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2967453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.61 |
| Max. Negotiated Rate |
$4,391.71 |
| Rate for Payer: Aetna Commercial |
$4,296.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,105.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,336.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,102.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,386.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,291.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,530.01
|
| Rate for Payer: Cash Price |
$1,377.00
|
| Rate for Payer: Cigna Commercial |
$4,391.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,671.38
|
| Rate for Payer: Health EOS Commercial |
$4,248.50
|
| Rate for Payer: HFN Commercial |
$4,391.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,818.88
|
| Rate for Payer: NAPHCARE Commercial |
$2,864.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,391.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,339.06
|
| Rate for Payer: Quartz Commercial |
$3,102.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,864.16
|
| Rate for Payer: The Alliance Commercial |
$2,386.80
|
| Rate for Payer: WEA Trust Commercial |
$2,625.48
|
| Rate for Payer: WPS Commercial |
$3,535.68
|
|
|
ZZZ***CANISTER W/GEL 500ML M8275063/5.S***DO NOT USE ON PICKLIST***ZZZ
|
Facility
|
OP
|
$869.00
|
|
| Hospital Charge Code |
3587513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.05 |
| Max. Negotiated Rate |
$831.46 |
| Rate for Payer: Aetna Commercial |
$813.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$777.23
|
| Rate for Payer: Aetna Managed Medicare |
$253.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$587.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$433.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.99
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$831.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.76
|
| Rate for Payer: Health EOS Commercial |
$804.35
|
| Rate for Payer: HFN Commercial |
$831.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$677.82
|
| Rate for Payer: Multiplan Commercial |
$723.01
|
| Rate for Payer: NAPHCARE Commercial |
$542.26
|
| Rate for Payer: Preferred Network Access Commercial |
$831.46
|
| Rate for Payer: Quartz Beloit One Network |
$442.84
|
| Rate for Payer: Quartz Commercial |
$587.44
|
| Rate for Payer: Quartz Medicare Advantage |
$542.26
|
| Rate for Payer: The Alliance Commercial |
$451.88
|
| Rate for Payer: WEA Trust Commercial |
$497.07
|
| Rate for Payer: WPS Commercial |
$669.39
|
|
|
ZZZ***CANISTER W/GEL 500ML M8275063/5.S***DO NOT USE ON PICKLIST***ZZZ
|
Facility
|
IP
|
$869.00
|
|
| Hospital Charge Code |
3587513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.84 |
| Max. Negotiated Rate |
$831.46 |
| Rate for Payer: Aetna Commercial |
$813.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$777.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.99
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$831.46
|
| Rate for Payer: Health EOS Commercial |
$804.35
|
| Rate for Payer: HFN Commercial |
$831.46
|
| Rate for Payer: Multiplan Commercial |
$723.01
|
| Rate for Payer: Preferred Network Access Commercial |
$831.46
|
| Rate for Payer: Quartz Beloit One Network |
$442.84
|
| Rate for Payer: Quartz Commercial |
$542.26
|
| Rate for Payer: WEA Trust Commercial |
$497.07
|
| Rate for Payer: WPS Commercial |
$669.39
|
|
|
zzzCANNULA 34FR VENOUS L7212 -- OBSOLETE/DISC
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Aetna Managed Medicare |
$377.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.27
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.88
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: NAPHCARE Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$876.10
|
| Rate for Payer: Quartz Medicare Advantage |
$808.70
|
| Rate for Payer: The Alliance Commercial |
$673.92
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
zzzCANNULA 34FR VENOUS L7212 -- OBSOLETE/DISC
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.44 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$808.70
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
zzzCAROTID ARTERY REPAIR
|
Facility
|
OP
|
$15,548.00
|
|
| Hospital Charge Code |
2959906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,527.58 |
| Max. Negotiated Rate |
$14,876.33 |
| Rate for Payer: Aetna Commercial |
$14,552.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,906.13
|
| Rate for Payer: Aetna Managed Medicare |
$4,527.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,510.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,084.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,761.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,570.06
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,876.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,048.94
|
| Rate for Payer: Health EOS Commercial |
$14,391.23
|
| Rate for Payer: HFN Commercial |
$14,876.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,127.44
|
| Rate for Payer: Multiplan Commercial |
$12,935.94
|
| Rate for Payer: NAPHCARE Commercial |
$9,701.95
|
| Rate for Payer: Preferred Network Access Commercial |
$14,876.33
|
| Rate for Payer: Quartz Beloit One Network |
$7,923.26
|
| Rate for Payer: Quartz Commercial |
$10,510.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,701.95
|
| Rate for Payer: The Alliance Commercial |
$8,084.96
|
| Rate for Payer: WEA Trust Commercial |
$8,893.46
|
| Rate for Payer: WPS Commercial |
$11,976.62
|
|
|
zzzCAROTID ARTERY REPAIR
|
Facility
|
IP
|
$15,548.00
|
|
| Hospital Charge Code |
2959906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,923.26 |
| Max. Negotiated Rate |
$14,876.33 |
| Rate for Payer: Aetna Commercial |
$14,552.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,906.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,570.06
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,876.33
|
| Rate for Payer: Health EOS Commercial |
$14,391.23
|
| Rate for Payer: HFN Commercial |
$14,876.33
|
| Rate for Payer: Multiplan Commercial |
$12,935.94
|
| Rate for Payer: Preferred Network Access Commercial |
$14,876.33
|
| Rate for Payer: Quartz Beloit One Network |
$7,923.26
|
| Rate for Payer: Quartz Commercial |
$9,701.95
|
| Rate for Payer: WEA Trust Commercial |
$8,893.46
|
| Rate for Payer: WPS Commercial |
$11,976.62
|
|
|
zzzCATARACT EXTRACTION, RESTOR IMPLANT
|
Facility
|
OP
|
$5,256.00
|
|
| Hospital Charge Code |
2960349
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,530.55 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,553.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,733.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.99
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,099.68
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,553.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.74
|
| Rate for Payer: The Alliance Commercial |
$2,733.12
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
zzzCATARACT EXTRACTION, RESTOR IMPLANT
|
Facility
|
IP
|
$5,256.00
|
|
| Hospital Charge Code |
2960349
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,678.46 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,279.74
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
zzzCATARACT EXTRACTION WITH TORIC LENS IMPLANT
|
Facility
|
IP
|
$5,256.00
|
|
| Hospital Charge Code |
2960438
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,678.46 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,279.74
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
zzzCATARACT EXTRACTION WITH TORIC LENS IMPLANT
|
Facility
|
OP
|
$5,256.00
|
|
| Hospital Charge Code |
2960438
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,530.55 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,553.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,733.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.99
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,099.68
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,553.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.74
|
| Rate for Payer: The Alliance Commercial |
$2,733.12
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
zzzCERVIX, COLD CONIZATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959936
|
|
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
|
|
|
zzzCERVIX, COLD CONIZATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959936
|
|
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
|
|
