|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
CDS GENERAL LAPAROSCOPY BOX DYNJ900885
|
Facility
|
OP
|
$4,296.00
|
|
| Hospital Charge Code |
4124770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$4,110.41 |
| Rate for Payer: Aetna Commercial |
$4,021.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,842.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,904.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,233.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,144.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,367.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$4,110.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,500.27
|
| Rate for Payer: Health EOS Commercial |
$3,976.38
|
| Rate for Payer: HFN Commercial |
$4,110.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,350.88
|
| Rate for Payer: Multiplan Commercial |
$3,574.27
|
| Rate for Payer: NAPHCARE Commercial |
$2,680.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,110.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.24
|
| Rate for Payer: Quartz Commercial |
$2,904.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,680.70
|
| Rate for Payer: The Alliance Commercial |
$2,233.92
|
| Rate for Payer: WEA Trust Commercial |
$2,457.31
|
| Rate for Payer: WPS Commercial |
$3,309.21
|
|
|
CDS GENERAL LAPAROSCOPY BOX DYNJ900885
|
Facility
|
IP
|
$4,296.00
|
|
| Hospital Charge Code |
4124770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,189.24 |
| Max. Negotiated Rate |
$4,110.41 |
| Rate for Payer: Aetna Commercial |
$4,021.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,842.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,367.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$4,110.41
|
| Rate for Payer: Health EOS Commercial |
$3,976.38
|
| Rate for Payer: HFN Commercial |
$4,110.41
|
| Rate for Payer: Multiplan Commercial |
$3,574.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,110.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.24
|
| Rate for Payer: Quartz Commercial |
$2,680.70
|
| Rate for Payer: WEA Trust Commercial |
$2,457.31
|
| Rate for Payer: WPS Commercial |
$3,309.21
|
|
|
CDS GYN LAPAROSCOPY BOX DYNJ900887
|
Facility
|
OP
|
$2,324.00
|
|
| Hospital Charge Code |
4124772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.75 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Aetna Managed Medicare |
$676.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,352.57
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.72
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,571.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,450.18
|
| Rate for Payer: The Alliance Commercial |
$1,208.48
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
CDS GYN LAPAROSCOPY BOX DYNJ900887
|
Facility
|
IP
|
$2,324.00
|
|
| Hospital Charge Code |
4124772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.31 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,450.18
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
CDS KNEE ARTHROSCOPY BOX DYNJ900876M
|
Facility
|
OP
|
$2,618.00
|
|
| Hospital Charge Code |
4124763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.36 |
| Max. Negotiated Rate |
$2,504.90 |
| Rate for Payer: Aetna Commercial |
$2,450.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,341.54
|
| Rate for Payer: Aetna Managed Medicare |
$762.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,769.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,361.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,306.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.04
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$2,504.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,523.68
|
| Rate for Payer: Health EOS Commercial |
$2,423.22
|
| Rate for Payer: HFN Commercial |
$2,504.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,042.04
|
| Rate for Payer: Multiplan Commercial |
$2,178.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,633.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,504.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.13
|
| Rate for Payer: Quartz Commercial |
$1,769.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,633.63
|
| Rate for Payer: The Alliance Commercial |
$1,361.36
|
| Rate for Payer: WEA Trust Commercial |
$1,497.50
|
| Rate for Payer: WPS Commercial |
$2,016.65
|
|
|
CDS KNEE ARTHROSCOPY BOX DYNJ900876M
|
Facility
|
IP
|
$2,618.00
|
|
| Hospital Charge Code |
4124763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,334.13 |
| Max. Negotiated Rate |
$2,504.90 |
| Rate for Payer: Aetna Commercial |
$2,450.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,341.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.04
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$2,504.90
|
| Rate for Payer: Health EOS Commercial |
$2,423.22
|
| Rate for Payer: HFN Commercial |
$2,504.90
|
| Rate for Payer: Multiplan Commercial |
$2,178.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,504.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.13
|
| Rate for Payer: Quartz Commercial |
$1,633.63
|
| Rate for Payer: WEA Trust Commercial |
$1,497.50
|
| Rate for Payer: WPS Commercial |
$2,016.65
|
|
|
CDS LOWER EXTREMITY BOX DYNJ900883
|
Facility
|
OP
|
$2,402.00
|
|
| Hospital Charge Code |
4124768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.46 |
| Max. Negotiated Rate |
$2,298.23 |
| Rate for Payer: Aetna Commercial |
$2,248.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.35
|
| Rate for Payer: Aetna Managed Medicare |
$699.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,623.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,249.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,199.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.98
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,298.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,397.96
|
| Rate for Payer: Health EOS Commercial |
$2,223.29
|
| Rate for Payer: HFN Commercial |
$2,298.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,873.56
|
| Rate for Payer: Multiplan Commercial |
$1,998.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.06
|
| Rate for Payer: Quartz Commercial |
$1,623.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,498.85
|
| Rate for Payer: The Alliance Commercial |
$1,249.04
|
| Rate for Payer: WEA Trust Commercial |
$1,373.94
|
| Rate for Payer: WPS Commercial |
$1,850.26
|
|
|
CDS LOWER EXTREMITY BOX DYNJ900883
|
Facility
|
IP
|
$2,402.00
|
|
| Hospital Charge Code |
4124768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,224.06 |
| Max. Negotiated Rate |
$2,298.23 |
| Rate for Payer: Aetna Commercial |
$2,248.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.98
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,298.23
|
| Rate for Payer: Health EOS Commercial |
$2,223.29
|
| Rate for Payer: HFN Commercial |
$2,298.23
|
| Rate for Payer: Multiplan Commercial |
$1,998.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.06
|
| Rate for Payer: Quartz Commercial |
$1,498.85
|
| Rate for Payer: WEA Trust Commercial |
$1,373.94
|
| Rate for Payer: WPS Commercial |
$1,850.26
|
|
|
CDS MAJOR PROCEDURE BOX DYNJ900877
|
Facility
|
IP
|
$1,551.00
|
|
| Hospital Charge Code |
4124764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.39 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$1,451.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.91
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$1,484.00
|
| Rate for Payer: Health EOS Commercial |
$1,435.61
|
| Rate for Payer: HFN Commercial |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.00
|
| Rate for Payer: Quartz Beloit One Network |
$790.39
|
| Rate for Payer: Quartz Commercial |
$967.82
|
| Rate for Payer: WEA Trust Commercial |
$887.17
|
| Rate for Payer: WPS Commercial |
$1,194.74
|
|
|
CDS MAJOR PROCEDURE BOX DYNJ900877
|
Facility
|
OP
|
$1,551.00
|
|
| Hospital Charge Code |
4124764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.65 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$1,451.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.21
|
| Rate for Payer: Aetna Managed Medicare |
$451.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.91
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$1,484.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.68
|
| Rate for Payer: Health EOS Commercial |
$1,435.61
|
| Rate for Payer: HFN Commercial |
$1,484.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.78
|
| Rate for Payer: Multiplan Commercial |
$1,290.43
|
| Rate for Payer: NAPHCARE Commercial |
$967.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.00
|
| Rate for Payer: Quartz Beloit One Network |
$790.39
|
| Rate for Payer: Quartz Commercial |
$1,048.48
|
| Rate for Payer: Quartz Medicare Advantage |
$967.82
|
| Rate for Payer: The Alliance Commercial |
$806.52
|
| Rate for Payer: WEA Trust Commercial |
$887.17
|
| Rate for Payer: WPS Commercial |
$1,194.74
|
|
|
CDS MAJOR VASCULAR BOX DYNJ901191K
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
HCPCS A4550
|
| Hospital Charge Code |
4494486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.34 |
| Max. Negotiated Rate |
$1,354.83 |
| Rate for Payer: Aetna Commercial |
$1,325.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,266.47
|
| Rate for Payer: Aetna Managed Medicare |
$412.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$957.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$736.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.50
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$1,354.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$824.11
|
| Rate for Payer: Health EOS Commercial |
$1,310.65
|
| Rate for Payer: HFN Commercial |
$1,354.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,104.48
|
| Rate for Payer: Multiplan Commercial |
$1,178.11
|
| Rate for Payer: NAPHCARE Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.83
|
| Rate for Payer: Quartz Beloit One Network |
$721.59
|
| Rate for Payer: Quartz Commercial |
$957.22
|
| Rate for Payer: Quartz Medicare Advantage |
$883.58
|
| Rate for Payer: The Alliance Commercial |
$736.32
|
| Rate for Payer: WEA Trust Commercial |
$809.95
|
| Rate for Payer: WPS Commercial |
$1,090.74
|
|
|
CDS MAJOR VASCULAR BOX DYNJ901191K
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
HCPCS A4550
|
| Hospital Charge Code |
4494486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.59 |
| Max. Negotiated Rate |
$1,354.83 |
| Rate for Payer: Aetna Commercial |
$1,325.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,266.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.50
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$1,354.83
|
| Rate for Payer: Health EOS Commercial |
$1,310.65
|
| Rate for Payer: HFN Commercial |
$1,354.83
|
| Rate for Payer: Multiplan Commercial |
$1,178.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.83
|
| Rate for Payer: Quartz Beloit One Network |
$721.59
|
| Rate for Payer: Quartz Commercial |
$883.58
|
| Rate for Payer: WEA Trust Commercial |
$809.95
|
| Rate for Payer: WPS Commercial |
$1,090.74
|
|
|
CDS MINOR LITHOTOMY BOX DYNJ900888
|
Facility
|
IP
|
$822.00
|
|
| Hospital Charge Code |
4115512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.89 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$512.93
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
CDS MINOR LITHOTOMY BOX DYNJ900888
|
Facility
|
OP
|
$822.00
|
|
| Hospital Charge Code |
4115512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.37 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$239.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.40
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.16
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$512.93
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$555.67
|
| Rate for Payer: Quartz Medicare Advantage |
$512.93
|
| Rate for Payer: The Alliance Commercial |
$427.44
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
CDS OPEN HEART ACCESSARY PACK DYNJ47503
|
Facility
|
IP
|
$5,316.00
|
|
| Hospital Charge Code |
4321743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,709.03 |
| Max. Negotiated Rate |
$5,086.35 |
| Rate for Payer: Aetna Commercial |
$4,975.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,754.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,930.18
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$5,086.35
|
| Rate for Payer: Health EOS Commercial |
$4,920.49
|
| Rate for Payer: HFN Commercial |
$5,086.35
|
| Rate for Payer: Multiplan Commercial |
$4,422.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,086.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.03
|
| Rate for Payer: Quartz Commercial |
$3,317.18
|
| Rate for Payer: WEA Trust Commercial |
$3,040.75
|
| Rate for Payer: WPS Commercial |
$4,094.91
|
|
|
CDS OPEN HEART ACCESSARY PACK DYNJ47503
|
Facility
|
OP
|
$5,316.00
|
|
| Hospital Charge Code |
4321743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,548.02 |
| Max. Negotiated Rate |
$5,086.35 |
| Rate for Payer: Aetna Commercial |
$4,975.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,754.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,548.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,593.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,764.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,930.18
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$5,086.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.91
|
| Rate for Payer: Health EOS Commercial |
$4,920.49
|
| Rate for Payer: HFN Commercial |
$5,086.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,146.48
|
| Rate for Payer: Multiplan Commercial |
$4,422.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,317.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,086.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.03
|
| Rate for Payer: Quartz Commercial |
$3,593.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,317.18
|
| Rate for Payer: The Alliance Commercial |
$2,764.32
|
| Rate for Payer: WEA Trust Commercial |
$3,040.75
|
| Rate for Payer: WPS Commercial |
$4,094.91
|
|
|
CDS OPEN HEART PART 1 DYNJ900985
|
Facility
|
OP
|
$5,121.00
|
|
| Hospital Charge Code |
4124777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.24 |
| Max. Negotiated Rate |
$4,899.77 |
| Rate for Payer: Aetna Commercial |
$4,793.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,491.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,461.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,662.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,556.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.70
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,899.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,980.42
|
| Rate for Payer: Health EOS Commercial |
$4,740.00
|
| Rate for Payer: HFN Commercial |
$4,899.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,994.38
|
| Rate for Payer: Multiplan Commercial |
$4,260.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.66
|
| Rate for Payer: Quartz Commercial |
$3,461.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,195.50
|
| Rate for Payer: The Alliance Commercial |
$2,662.92
|
| Rate for Payer: WEA Trust Commercial |
$2,929.21
|
| Rate for Payer: WPS Commercial |
$3,944.71
|
|
|
CDS OPEN HEART PART 1 DYNJ900985
|
Facility
|
IP
|
$5,121.00
|
|
| Hospital Charge Code |
4124777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,609.66 |
| Max. Negotiated Rate |
$4,899.77 |
| Rate for Payer: Aetna Commercial |
$4,793.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.70
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,899.77
|
| Rate for Payer: Health EOS Commercial |
$4,740.00
|
| Rate for Payer: HFN Commercial |
$4,899.77
|
| Rate for Payer: Multiplan Commercial |
$4,260.67
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.66
|
| Rate for Payer: Quartz Commercial |
$3,195.50
|
| Rate for Payer: WEA Trust Commercial |
$2,929.21
|
| Rate for Payer: WPS Commercial |
$3,944.71
|
|
|
CDS OPEN HEART PART 2 DYNJ901075
|
Facility
|
IP
|
$12,959.00
|
|
| Hospital Charge Code |
4318423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,603.91 |
| Max. Negotiated Rate |
$12,399.17 |
| Rate for Payer: Aetna Commercial |
$12,129.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,590.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,143.00
|
| Rate for Payer: Cash Price |
$3,887.70
|
| Rate for Payer: Cigna Commercial |
$12,399.17
|
| Rate for Payer: Health EOS Commercial |
$11,994.85
|
| Rate for Payer: HFN Commercial |
$12,399.17
|
| Rate for Payer: Multiplan Commercial |
$10,781.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,399.17
|
| Rate for Payer: Quartz Beloit One Network |
$6,603.91
|
| Rate for Payer: Quartz Commercial |
$8,086.42
|
| Rate for Payer: WEA Trust Commercial |
$7,412.55
|
| Rate for Payer: WPS Commercial |
$9,982.32
|
|
|
CDS OPEN HEART PART 2 DYNJ901075
|
Facility
|
OP
|
$12,959.00
|
|
| Hospital Charge Code |
4318423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,773.66 |
| Max. Negotiated Rate |
$12,399.17 |
| Rate for Payer: Aetna Commercial |
$12,129.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,590.53
|
| Rate for Payer: Aetna Managed Medicare |
$3,773.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,760.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,738.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,469.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,143.00
|
| Rate for Payer: Cash Price |
$3,887.70
|
| Rate for Payer: Cigna Commercial |
$12,399.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,542.14
|
| Rate for Payer: Health EOS Commercial |
$11,994.85
|
| Rate for Payer: HFN Commercial |
$12,399.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,108.02
|
| Rate for Payer: Multiplan Commercial |
$10,781.89
|
| Rate for Payer: NAPHCARE Commercial |
$8,086.42
|
| Rate for Payer: Preferred Network Access Commercial |
$12,399.17
|
| Rate for Payer: Quartz Beloit One Network |
$6,603.91
|
| Rate for Payer: Quartz Commercial |
$8,760.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,086.42
|
| Rate for Payer: The Alliance Commercial |
$6,738.68
|
| Rate for Payer: WEA Trust Commercial |
$7,412.55
|
| Rate for Payer: WPS Commercial |
$9,982.32
|
|
|
CDS PACK ANGIO TRAY DYNJ30565
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2969549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
CDS PACK ANGIO TRAY DYNJ30565
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2969549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$57.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.66
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$122.93
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$122.93
|
| Rate for Payer: The Alliance Commercial |
$102.44
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
