|
NEEDLE ANCHOR DISPOSABLE 1825-4D
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
NEEDLE ANCHOR DISP SIZE 5 1824-5DC
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
NEEDLE ANCHOR DISP SIZE 5 1824-5DC
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
NEEDLE ANCHOR TAPER 1/2 CIRCLE 1824-4DC
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
NEEDLE ANCHOR TAPER 1/2 CIRCLE 1824-4DC
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
NEEDLE AND CATHETER BIOPSY, ASPIRATION, LAVAGE AND INTUBATION
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
EAPG 00061
|
| Min. Negotiated Rate |
$414.51 |
| Max. Negotiated Rate |
$431.09 |
| Rate for Payer: Anthem Medicaid |
$414.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$414.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$414.51
|
| Rate for Payer: Dean Health Medicaid |
$414.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$414.51
|
| Rate for Payer: Managed Health Services Medicaid |
$431.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$414.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$414.51
|
| Rate for Payer: United Healthcare Medicaid |
$414.51
|
|
|
NEEDLE ANESTHESIA REINFORCED 27GA X 3 1/2 IN RAN-027-5
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
5563484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
|
NEEDLE ANESTHESIA REINFORCED 27GA X 3 1/2 IN RAN-027-5
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
5563484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Aetna Managed Medicare |
$52.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.76
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: NAPHCARE Commercial |
$112.32
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$121.68
|
| Rate for Payer: Quartz Medicare Advantage |
$112.32
|
| Rate for Payer: The Alliance Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
|
Needle Aspiration - Bronchoscopy Charge
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
2990187
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$14,596.05 |
| Rate for Payer: Aetna Commercial |
$5,017.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,794.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,624.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,787.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,676.21
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,954.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cash Price |
$1,608.30
|
| Rate for Payer: Cash Price |
$1,608.30
|
| Rate for Payer: Cigna Commercial |
$5,129.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Health EOS Commercial |
$4,962.14
|
| Rate for Payer: HFN Commercial |
$5,129.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: Multiplan Commercial |
$4,460.35
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,129.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,731.97
|
| Rate for Payer: Quartz Commercial |
$3,624.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$6,670.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,181.58
|
| Rate for Payer: WEA Trust Commercial |
$3,066.49
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
| Rate for Payer: WPS Commercial |
$4,129.58
|
|
|
Needle Aspiration - Bronchoscopy Charge
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
2990187
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2,731.97 |
| Max. Negotiated Rate |
$5,129.40 |
| Rate for Payer: Aetna Commercial |
$5,017.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,794.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,954.98
|
| Rate for Payer: Cash Price |
$1,608.30
|
| Rate for Payer: Cigna Commercial |
$5,129.40
|
| Rate for Payer: Health EOS Commercial |
$4,962.14
|
| Rate for Payer: HFN Commercial |
$5,129.40
|
| Rate for Payer: Multiplan Commercial |
$4,460.35
|
| Rate for Payer: Preferred Network Access Commercial |
$5,129.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,731.97
|
| Rate for Payer: Quartz Commercial |
$3,345.26
|
| Rate for Payer: WEA Trust Commercial |
$3,066.49
|
| Rate for Payer: WPS Commercial |
$4,129.58
|
|
|
NEEDLE BIOPSY CHEST LINING 32400
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
3014413
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.66 |
| Max. Negotiated Rate |
$1,030.48 |
| Rate for Payer: Aetna Commercial |
$1,030.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$70.66
|
| Rate for Payer: Anthem Medicare Advantage |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.66
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$1,030.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.66
|
| Rate for Payer: Health EOS Commercial |
$987.10
|
| Rate for Payer: HFN Commercial |
$1,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.66
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$105.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$477.28
|
| Rate for Payer: Quartz Commercial |
$618.29
|
| Rate for Payer: Quartz Medicare Advantage |
$70.66
|
| Rate for Payer: The Alliance Commercial |
$300.29
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.66
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$317.96
|
|
|
NEEDLE BIOPSY, LYMPH NODES 38505
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
3014582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$1,035.42 |
| Rate for Payer: Aetna Commercial |
$1,035.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.33
|
| Rate for Payer: Aetna Managed Medicare |
$72.97
|
| Rate for Payer: Anthem Medicare Advantage |
$72.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.97
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$1,035.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.97
|
| Rate for Payer: Health EOS Commercial |
$991.83
|
| Rate for Payer: HFN Commercial |
$1,035.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.97
|
| Rate for Payer: Multiplan Commercial |
$871.94
|
| Rate for Payer: NAPHCARE Commercial |
$109.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.42
|
| Rate for Payer: Quartz Beloit One Network |
$479.56
|
| Rate for Payer: Quartz Commercial |
$621.25
|
| Rate for Payer: Quartz Medicare Advantage |
$72.97
|
| Rate for Payer: The Alliance Commercial |
$310.11
|
| Rate for Payer: United Healthcare Medicaid |
$141.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.97
|
| Rate for Payer: WEA Trust Commercial |
$599.46
|
| Rate for Payer: WPS Commercial |
$328.35
|
|
|
NEEDLE BIOPSY OF LIVER 47000
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
3014853
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.71 |
| Max. Negotiated Rate |
$765.70 |
| Rate for Payer: Aetna Commercial |
$765.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Aetna Managed Medicare |
$74.71
|
| Rate for Payer: Anthem Medicare Advantage |
$74.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.71
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$765.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.71
|
| Rate for Payer: Health EOS Commercial |
$733.46
|
| Rate for Payer: HFN Commercial |
$765.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$308.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.71
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: NAPHCARE Commercial |
$112.07
|
| Rate for Payer: Preferred Network Access Commercial |
$765.70
|
| Rate for Payer: Quartz Beloit One Network |
$354.64
|
| Rate for Payer: Quartz Commercial |
$459.42
|
| Rate for Payer: Quartz Medicare Advantage |
$74.71
|
| Rate for Payer: The Alliance Commercial |
$317.53
|
| Rate for Payer: United Healthcare Medicaid |
$126.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.71
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$336.21
|
|
|
Needle biopsy of Liver 47379-47000
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
5355250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$623.43 |
| Rate for Payer: Aetna Commercial |
$623.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.37
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$623.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.74
|
| Rate for Payer: Health EOS Commercial |
$597.18
|
| Rate for Payer: HFN Commercial |
$623.43
|
| Rate for Payer: Multiplan Commercial |
$524.99
|
| Rate for Payer: Preferred Network Access Commercial |
$623.43
|
| Rate for Payer: Quartz Beloit One Network |
$288.75
|
| Rate for Payer: Quartz Commercial |
$374.06
|
| Rate for Payer: The Alliance Commercial |
$328.12
|
| Rate for Payer: WEA Trust Commercial |
$360.93
|
| Rate for Payer: WPS Commercial |
$486.06
|
|
|
NEEDLE BONE BIOPSY 13ga 10cm #DBBN-13-10.0-M2
|
Facility
|
IP
|
$877.00
|
|
| Hospital Charge Code |
2971722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.92 |
| Max. Negotiated Rate |
$839.11 |
| Rate for Payer: Aetna Commercial |
$820.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$784.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.40
|
| Rate for Payer: Cash Price |
$263.10
|
| Rate for Payer: Cigna Commercial |
$839.11
|
| Rate for Payer: Health EOS Commercial |
$811.75
|
| Rate for Payer: HFN Commercial |
$839.11
|
| Rate for Payer: Multiplan Commercial |
$729.66
|
| Rate for Payer: Preferred Network Access Commercial |
$839.11
|
| Rate for Payer: Quartz Beloit One Network |
$446.92
|
| Rate for Payer: Quartz Commercial |
$547.25
|
| Rate for Payer: WEA Trust Commercial |
$501.64
|
| Rate for Payer: WPS Commercial |
$675.55
|
|
|
NEEDLE BONE BIOPSY 13ga 10cm #DBBN-13-10.0-M2
|
Facility
|
OP
|
$877.00
|
|
| Hospital Charge Code |
2971722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.38 |
| Max. Negotiated Rate |
$839.11 |
| Rate for Payer: Aetna Commercial |
$820.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$784.39
|
| Rate for Payer: Aetna Managed Medicare |
$255.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$592.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$437.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.40
|
| Rate for Payer: Cash Price |
$263.10
|
| Rate for Payer: Cigna Commercial |
$839.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$510.41
|
| Rate for Payer: Health EOS Commercial |
$811.75
|
| Rate for Payer: HFN Commercial |
$839.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.06
|
| Rate for Payer: Multiplan Commercial |
$729.66
|
| Rate for Payer: NAPHCARE Commercial |
$547.25
|
| Rate for Payer: Preferred Network Access Commercial |
$839.11
|
| Rate for Payer: Quartz Beloit One Network |
$446.92
|
| Rate for Payer: Quartz Commercial |
$592.85
|
| Rate for Payer: Quartz Medicare Advantage |
$547.25
|
| Rate for Payer: The Alliance Commercial |
$456.04
|
| Rate for Payer: WEA Trust Commercial |
$501.64
|
| Rate for Payer: WPS Commercial |
$675.55
|
|
|
NEEDLE BONE MARROW & ASPIRATION ILLINOIS 15GA DIN1515X
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
2963142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.33 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
NEEDLE BONE MARROW & ASPIRATION ILLINOIS 15GA DIN1515X
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
2963142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.19 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$116.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.22
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.22
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$248.98
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$269.72
|
| Rate for Payer: Quartz Medicare Advantage |
$248.98
|
| Rate for Payer: The Alliance Commercial |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
NEEDLE COUNTER 40CT MAGNET/FOAM BLOCK DYNJNC40F
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
2969222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
NEEDLE COUNTER 40CT MAGNET/FOAM BLOCK DYNJNC40F
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
2969222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
NEEDLE CYSTOTOME 585004
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
2968994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
NEEDLE CYSTOTOME 585004
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
2968994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$58.76
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
NEEDLE DELIVERY 8G X10CM NORIAN DLS-7083-01S
|
Facility
|
IP
|
$946.00
|
|
| Hospital Charge Code |
2966303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.08 |
| Max. Negotiated Rate |
$905.13 |
| Rate for Payer: Aetna Commercial |
$885.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.44
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$905.13
|
| Rate for Payer: Health EOS Commercial |
$875.62
|
| Rate for Payer: HFN Commercial |
$905.13
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: Preferred Network Access Commercial |
$905.13
|
| Rate for Payer: Quartz Beloit One Network |
$482.08
|
| Rate for Payer: Quartz Commercial |
$590.30
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$728.70
|
|
|
NEEDLE DELIVERY 8G X10CM NORIAN DLS-7083-01S
|
Facility
|
OP
|
$946.00
|
|
| Hospital Charge Code |
2966303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.48 |
| Max. Negotiated Rate |
$905.13 |
| Rate for Payer: Aetna Commercial |
$885.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$275.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$639.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$472.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.44
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$905.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.57
|
| Rate for Payer: Health EOS Commercial |
$875.62
|
| Rate for Payer: HFN Commercial |
$905.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.88
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$590.30
|
| Rate for Payer: Preferred Network Access Commercial |
$905.13
|
| Rate for Payer: Quartz Beloit One Network |
$482.08
|
| Rate for Payer: Quartz Commercial |
$639.50
|
| Rate for Payer: Quartz Medicare Advantage |
$590.30
|
| Rate for Payer: The Alliance Commercial |
$491.92
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$728.70
|
|
|
NEEDLE EBUS ECHO-HD-22-EBUS-O G52011
|
Facility
|
OP
|
$2,345.00
|
|
| Hospital Charge Code |
5384681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.86 |
| Max. Negotiated Rate |
$2,243.70 |
| Rate for Payer: Aetna Commercial |
$2,194.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.37
|
| Rate for Payer: Aetna Managed Medicare |
$682.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,170.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.56
|
| Rate for Payer: Cash Price |
$703.50
|
| Rate for Payer: Cigna Commercial |
$2,243.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,364.79
|
| Rate for Payer: Health EOS Commercial |
$2,170.53
|
| Rate for Payer: HFN Commercial |
$2,243.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.10
|
| Rate for Payer: Multiplan Commercial |
$1,951.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.01
|
| Rate for Payer: Quartz Commercial |
$1,585.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.28
|
| Rate for Payer: The Alliance Commercial |
$1,219.40
|
| Rate for Payer: WEA Trust Commercial |
$1,341.34
|
| Rate for Payer: WPS Commercial |
$1,806.35
|
|
