|
zzzTYMPANOMASTOIDECTOMY
|
Facility
|
IP
|
$5,030.00
|
|
| Hospital Charge Code |
2960462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,563.29 |
| Max. Negotiated Rate |
$4,812.70 |
| Rate for Payer: Aetna Commercial |
$4,708.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,498.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,772.54
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,812.70
|
| Rate for Payer: Health EOS Commercial |
$4,655.77
|
| Rate for Payer: HFN Commercial |
$4,812.70
|
| Rate for Payer: Multiplan Commercial |
$4,184.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,812.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.29
|
| Rate for Payer: Quartz Commercial |
$3,138.72
|
| Rate for Payer: WEA Trust Commercial |
$2,877.16
|
| Rate for Payer: WPS Commercial |
$3,874.61
|
|
|
zzzTYMPANOMASTOIDECTOMY
|
Facility
|
OP
|
$5,030.00
|
|
| Hospital Charge Code |
2960462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,464.74 |
| Max. Negotiated Rate |
$4,812.70 |
| Rate for Payer: Aetna Commercial |
$4,708.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,498.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,464.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,400.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,615.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,510.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,772.54
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,812.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,927.46
|
| Rate for Payer: Health EOS Commercial |
$4,655.77
|
| Rate for Payer: HFN Commercial |
$4,812.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,923.40
|
| Rate for Payer: Multiplan Commercial |
$4,184.96
|
| Rate for Payer: NAPHCARE Commercial |
$3,138.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,812.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.29
|
| Rate for Payer: Quartz Commercial |
$3,400.28
|
| Rate for Payer: Quartz Medicare Advantage |
$3,138.72
|
| Rate for Payer: The Alliance Commercial |
$2,615.60
|
| Rate for Payer: WEA Trust Commercial |
$2,877.16
|
| Rate for Payer: WPS Commercial |
$3,874.61
|
|
|
zzzTYMPANOSTOMY WITH T-TUBES, BILATERAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959855
|
|
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
|
|
|
zzzTYMPANOSTOMY WITH T-TUBES, BILATERAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959855
|
|
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
|
|
|
zzzURETEROTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960477
|
|
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
|
|
|
zzzURETEROTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960477
|
|
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
|
|
|
zzzUVULOPLASTY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960485
|
|
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
|
|
|
zzzUVULOPLASTY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960485
|
|
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
|
|
|
zzzVARICOSE VEIN LIGATION AND STRIPPING
|
Facility
|
OP
|
$1,048.00
|
|
| Hospital Charge Code |
2960495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$305.18 |
| Max. Negotiated Rate |
$1,002.73 |
| Rate for Payer: Aetna Commercial |
$980.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.33
|
| Rate for Payer: Aetna Managed Medicare |
$305.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$523.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.66
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$1,002.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$609.94
|
| Rate for Payer: Health EOS Commercial |
$970.03
|
| Rate for Payer: HFN Commercial |
$1,002.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.44
|
| Rate for Payer: Multiplan Commercial |
$871.94
|
| Rate for Payer: NAPHCARE Commercial |
$653.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,002.73
|
| Rate for Payer: Quartz Beloit One Network |
$534.06
|
| Rate for Payer: Quartz Commercial |
$708.45
|
| Rate for Payer: Quartz Medicare Advantage |
$653.95
|
| Rate for Payer: The Alliance Commercial |
$544.96
|
| Rate for Payer: WEA Trust Commercial |
$599.46
|
| Rate for Payer: WPS Commercial |
$807.27
|
|
|
zzzVARICOSE VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$1,048.00
|
|
| Hospital Charge Code |
2960495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$534.06 |
| Max. Negotiated Rate |
$1,002.73 |
| Rate for Payer: Aetna Commercial |
$980.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.66
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$1,002.73
|
| Rate for Payer: Health EOS Commercial |
$970.03
|
| Rate for Payer: HFN Commercial |
$1,002.73
|
| Rate for Payer: Multiplan Commercial |
$871.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,002.73
|
| Rate for Payer: Quartz Beloit One Network |
$534.06
|
| Rate for Payer: Quartz Commercial |
$653.95
|
| Rate for Payer: WEA Trust Commercial |
$599.46
|
| Rate for Payer: WPS Commercial |
$807.27
|
|
|
zzzWOUND CLOSURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960510
|
|
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
|
|
|
zzzWOUND CLOSURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960510
|
|
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
|
|
|
zzzWOUND REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960513
|
|
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
|
|
|
zzzWOUND REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960513
|
|
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
|
|
|
zzzWOUND REPAIR, PRIMARY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960511
|
|
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
|
|
|
zzzWOUND REPAIR, PRIMARY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960511
|
|
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
|
|
|
zzzWRIST MANIPULATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960223
|
|
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
|
|
|
zzzWRIST MANIPULATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960223
|
|
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
|
|
|
zzzzCLOSURE DEVICE MYNX 6F/7F MX6721**ACCESS CLOSURE
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.35 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,810.22
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
zzzzCLOSURE DEVICE MYNX 6F/7F MX6721**ACCESS CLOSURE
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613524
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.77 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$844.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,508.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.38
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.78
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,961.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.22
|
| Rate for Payer: The Alliance Commercial |
$1,508.52
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
