|
zzzCUTANEOUS FLAP
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960073
|
|
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
|
|
|
zzzDECORTICATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959993
|
|
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
|
|
|
zzzDECORTICATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959993
|
|
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 *** DO NOT ORDER *** KIT LITHOCLAST TRILOGY PROBE 3.9MM X 350MM & STONE CATCHER M0068403540 ***
|
Facility
|
IP
|
$6,666.00
|
|
| Hospital Charge Code |
5459833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,396.99 |
| Max. Negotiated Rate |
$6,378.03 |
| Rate for Payer: Aetna Commercial |
$6,239.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,962.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,674.30
|
| Rate for Payer: Cash Price |
$1,999.80
|
| Rate for Payer: Cigna Commercial |
$6,378.03
|
| Rate for Payer: Health EOS Commercial |
$6,170.05
|
| Rate for Payer: HFN Commercial |
$6,378.03
|
| Rate for Payer: Multiplan Commercial |
$5,546.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6,378.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,396.99
|
| Rate for Payer: Quartz Commercial |
$4,159.58
|
| Rate for Payer: WEA Trust Commercial |
$3,812.95
|
| Rate for Payer: WPS Commercial |
$5,134.82
|
|
|
ZZZ *** DO NOT ORDER *** KIT LITHOCLAST TRILOGY PROBE 3.9MM X 350MM & STONE CATCHER M0068403540 ***
|
Facility
|
OP
|
$6,666.00
|
|
| Hospital Charge Code |
5459833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,941.14 |
| Max. Negotiated Rate |
$6,378.03 |
| Rate for Payer: Aetna Commercial |
$6,239.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,962.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,941.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,506.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,466.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,327.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,674.30
|
| Rate for Payer: Cash Price |
$1,999.80
|
| Rate for Payer: Cigna Commercial |
$6,378.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,879.61
|
| Rate for Payer: Health EOS Commercial |
$6,170.05
|
| Rate for Payer: HFN Commercial |
$6,378.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,199.48
|
| Rate for Payer: Multiplan Commercial |
$5,546.11
|
| Rate for Payer: NAPHCARE Commercial |
$4,159.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,378.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,396.99
|
| Rate for Payer: Quartz Commercial |
$4,506.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,159.58
|
| Rate for Payer: The Alliance Commercial |
$3,466.32
|
| Rate for Payer: WEA Trust Commercial |
$3,812.95
|
| Rate for Payer: WPS Commercial |
$5,134.82
|
|
|
zzzEAR SURGERY
|
Facility
|
OP
|
$4,643.00
|
|
| Hospital Charge Code |
2960000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,352.04 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,352.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,138.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,414.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,317.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,702.23
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,621.54
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,897.23
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$3,138.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,897.23
|
| Rate for Payer: The Alliance Commercial |
$2,414.36
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
zzzEAR SURGERY
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
2960000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,366.07 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$2,897.23
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
zzzECTROPION REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960002
|
|
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
|
|
|
zzzECTROPION REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960002
|
|
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
|
|
|
zzzELBOW MANIPULATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960218
|
|
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
|
|
|
zzzELBOW MANIPULATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960218
|
|
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
|
|
|
ZZZ***ESMARK BANDAGE 6X9 DYNJ05918 (SUB)*** DUPLICATE *** USE 3007080 ***
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
5810083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Aetna Managed Medicare |
$20.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.32
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.38
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: NAPHCARE Commercial |
$44.30
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: Quartz Medicare Advantage |
$44.30
|
| Rate for Payer: The Alliance Commercial |
$36.92
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
ZZZ***ESMARK BANDAGE 6X9 DYNJ05918 (SUB)*** DUPLICATE *** USE 3007080 ***
|
Facility
|
IP
|
$71.00
|
|
| Hospital Charge Code |
5810083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$44.30
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
zzzEXCISION, LIPOMA
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960028
|
|
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
|
|
|
zzzEXCISION, LIPOMA
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960028
|
|
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
|
|
|
zzzEXTENSOR TENDON REPAIR
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
zzzEXTENSOR TENDON REPAIR
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
zzzEYE EVISCERATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960023
|
|
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
|
|
|
zzzEYE EVISCERATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960023
|
|
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
|
|
|
zzzFASCIAL MUSCULAR FLAP
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960074
|
|
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
|
|
|
zzzFASCIAL MUSCULAR FLAP
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960074
|
|
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
|
|
|
zzzFASCIOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960048
|
|
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
|
|
|
zzzFASCIOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960048
|
|
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
|
|
|
zzzFEMORAL DISTAL BYPASS GRAFT
|
Facility
|
OP
|
$15,548.00
|
|
| Hospital Charge Code |
2960065
|
|
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
|
|
|
zzzFEMORAL DISTAL BYPASS GRAFT
|
Facility
|
IP
|
$15,548.00
|
|
| Hospital Charge Code |
2960065
|
|
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
|
|
