|
PROBE AR SCOPE MEASUREMENT 220MM60 AR-4070-01
|
Facility
|
IP
|
$2,926.00
|
|
| Hospital Charge Code |
5611601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.09 |
| Max. Negotiated Rate |
$2,799.60 |
| Rate for Payer: Aetna Commercial |
$2,738.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,612.81
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,799.60
|
| Rate for Payer: Health EOS Commercial |
$2,708.31
|
| Rate for Payer: HFN Commercial |
$2,799.60
|
| Rate for Payer: Multiplan Commercial |
$2,434.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.09
|
| Rate for Payer: Quartz Commercial |
$1,825.82
|
| Rate for Payer: WEA Trust Commercial |
$1,673.67
|
| Rate for Payer: WPS Commercial |
$2,253.90
|
|
|
PROBE AR SCOPE MEASUREMENT 220MM60 AR-4070-01
|
Facility
|
OP
|
$2,926.00
|
|
| Hospital Charge Code |
5611601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.05 |
| Max. Negotiated Rate |
$2,799.60 |
| Rate for Payer: Aetna Commercial |
$2,738.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.01
|
| Rate for Payer: Aetna Managed Medicare |
$852.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,977.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,521.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,460.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,612.81
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,799.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,702.93
|
| Rate for Payer: Health EOS Commercial |
$2,708.31
|
| Rate for Payer: HFN Commercial |
$2,799.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,282.28
|
| Rate for Payer: Multiplan Commercial |
$2,434.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,825.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.09
|
| Rate for Payer: Quartz Commercial |
$1,977.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,825.82
|
| Rate for Payer: The Alliance Commercial |
$1,521.52
|
| Rate for Payer: WEA Trust Commercial |
$1,673.67
|
| Rate for Payer: WPS Commercial |
$2,253.90
|
|
|
PROBE BILIARY BALLOON 5 FR
|
Facility
|
IP
|
$1,172.00
|
|
| Hospital Charge Code |
2963300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,121.37 |
| Rate for Payer: Aetna Commercial |
$1,096.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.01
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,121.37
|
| Rate for Payer: Health EOS Commercial |
$1,084.80
|
| Rate for Payer: HFN Commercial |
$1,121.37
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.37
|
| Rate for Payer: Quartz Beloit One Network |
$597.25
|
| Rate for Payer: Quartz Commercial |
$731.33
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$902.79
|
|
|
PROBE BILIARY BALLOON 5 FR
|
Facility
|
OP
|
$1,172.00
|
|
| Hospital Charge Code |
2963300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.29 |
| Max. Negotiated Rate |
$1,121.37 |
| Rate for Payer: Aetna Commercial |
$1,096.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Aetna Managed Medicare |
$341.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$792.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$609.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$585.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.01
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,121.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.10
|
| Rate for Payer: Health EOS Commercial |
$1,084.80
|
| Rate for Payer: HFN Commercial |
$1,121.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$914.16
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: NAPHCARE Commercial |
$731.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.37
|
| Rate for Payer: Quartz Beloit One Network |
$597.25
|
| Rate for Payer: Quartz Commercial |
$792.27
|
| Rate for Payer: Quartz Medicare Advantage |
$731.33
|
| Rate for Payer: The Alliance Commercial |
$609.44
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$902.79
|
|
|
PROBE BILIARY BALLOON 6 FRENCH
|
Facility
|
OP
|
$1,129.00
|
|
| Hospital Charge Code |
2963299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.76 |
| Max. Negotiated Rate |
$1,080.23 |
| Rate for Payer: Aetna Commercial |
$1,056.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Aetna Managed Medicare |
$328.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$763.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$587.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$563.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.30
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,080.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$657.08
|
| Rate for Payer: Health EOS Commercial |
$1,045.00
|
| Rate for Payer: HFN Commercial |
$1,080.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$880.62
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: NAPHCARE Commercial |
$704.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,080.23
|
| Rate for Payer: Quartz Beloit One Network |
$575.34
|
| Rate for Payer: Quartz Commercial |
$763.20
|
| Rate for Payer: Quartz Medicare Advantage |
$704.50
|
| Rate for Payer: The Alliance Commercial |
$587.08
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$869.67
|
|
|
PROBE BILIARY BALLOON 6 FRENCH
|
Facility
|
IP
|
$1,129.00
|
|
| Hospital Charge Code |
2963299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.34 |
| Max. Negotiated Rate |
$1,080.23 |
| Rate for Payer: Aetna Commercial |
$1,056.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.30
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,080.23
|
| Rate for Payer: Health EOS Commercial |
$1,045.00
|
| Rate for Payer: HFN Commercial |
$1,080.23
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,080.23
|
| Rate for Payer: Quartz Beloit One Network |
$575.34
|
| Rate for Payer: Quartz Commercial |
$704.50
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$869.67
|
|
|
PROBE CIRCUMFERENTIAL FIRE APC 20132-218
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5685801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,172.08 |
| Max. Negotiated Rate |
$2,200.64 |
| Rate for Payer: Aetna Commercial |
$2,152.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,057.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,267.76
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$2,200.64
|
| Rate for Payer: Health EOS Commercial |
$2,128.88
|
| Rate for Payer: HFN Commercial |
$2,200.64
|
| Rate for Payer: Multiplan Commercial |
$1,913.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.08
|
| Rate for Payer: Quartz Commercial |
$1,435.20
|
| Rate for Payer: WEA Trust Commercial |
$1,315.60
|
| Rate for Payer: WPS Commercial |
$1,771.69
|
|
|
PROBE CIRCUMFERENTIAL FIRE APC 20132-218
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5685801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.76 |
| Max. Negotiated Rate |
$2,200.64 |
| Rate for Payer: Aetna Commercial |
$2,152.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,057.12
|
| Rate for Payer: Aetna Managed Medicare |
$669.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,554.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,196.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,148.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,267.76
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$2,200.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,338.60
|
| Rate for Payer: Health EOS Commercial |
$2,128.88
|
| Rate for Payer: HFN Commercial |
$2,200.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,435.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.08
|
| Rate for Payer: Quartz Commercial |
$1,554.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,435.20
|
| Rate for Payer: The Alliance Commercial |
$1,196.00
|
| Rate for Payer: WEA Trust Commercial |
$1,315.60
|
| Rate for Payer: WPS Commercial |
$1,771.69
|
|
|
PROBE CRYO-ABLATION 20MM CRYO2
|
Facility
|
OP
|
$15,713.00
|
|
| Hospital Charge Code |
2964755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,575.63 |
| Max. Negotiated Rate |
$15,034.20 |
| Rate for Payer: Aetna Commercial |
$14,707.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,053.71
|
| Rate for Payer: Aetna Managed Medicare |
$4,575.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,621.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,170.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,843.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,661.01
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$15,034.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,144.97
|
| Rate for Payer: Health EOS Commercial |
$14,543.95
|
| Rate for Payer: HFN Commercial |
$15,034.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,256.14
|
| Rate for Payer: Multiplan Commercial |
$13,073.22
|
| Rate for Payer: NAPHCARE Commercial |
$9,804.91
|
| Rate for Payer: Preferred Network Access Commercial |
$15,034.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,007.34
|
| Rate for Payer: Quartz Commercial |
$10,621.99
|
| Rate for Payer: Quartz Medicare Advantage |
$9,804.91
|
| Rate for Payer: The Alliance Commercial |
$8,170.76
|
| Rate for Payer: WEA Trust Commercial |
$8,987.84
|
| Rate for Payer: WPS Commercial |
$12,103.72
|
|
|
PROBE CRYO-ABLATION 20MM CRYO2
|
Facility
|
IP
|
$15,713.00
|
|
| Hospital Charge Code |
2964755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,007.34 |
| Max. Negotiated Rate |
$15,034.20 |
| Rate for Payer: Aetna Commercial |
$14,707.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,053.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,661.01
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$15,034.20
|
| Rate for Payer: Health EOS Commercial |
$14,543.95
|
| Rate for Payer: HFN Commercial |
$15,034.20
|
| Rate for Payer: Multiplan Commercial |
$13,073.22
|
| Rate for Payer: Preferred Network Access Commercial |
$15,034.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,007.34
|
| Rate for Payer: Quartz Commercial |
$9,804.91
|
| Rate for Payer: WEA Trust Commercial |
$8,987.84
|
| Rate for Payer: WPS Commercial |
$12,103.72
|
|
|
PROBE ENDOCARE CRYOPROBE PCS-17
|
Facility
|
IP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
5307097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,117.22 |
| Max. Negotiated Rate |
$5,852.75 |
| Rate for Payer: Aetna Commercial |
$5,725.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,471.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,371.69
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,852.75
|
| Rate for Payer: Health EOS Commercial |
$5,661.90
|
| Rate for Payer: HFN Commercial |
$5,852.75
|
| Rate for Payer: Multiplan Commercial |
$5,089.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,852.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,117.22
|
| Rate for Payer: Quartz Commercial |
$3,817.01
|
| Rate for Payer: WEA Trust Commercial |
$3,498.92
|
| Rate for Payer: WPS Commercial |
$4,711.93
|
|
|
PROBE ENDOCARE CRYOPROBE PCS-17
|
Facility
|
OP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
5307097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,781.27 |
| Max. Negotiated Rate |
$5,852.75 |
| Rate for Payer: Aetna Commercial |
$5,725.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,471.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,781.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,135.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,180.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,053.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,371.69
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,852.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,560.09
|
| Rate for Payer: Health EOS Commercial |
$5,661.90
|
| Rate for Payer: HFN Commercial |
$5,852.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,771.26
|
| Rate for Payer: Multiplan Commercial |
$5,089.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,817.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,852.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,117.22
|
| Rate for Payer: Quartz Commercial |
$4,135.09
|
| Rate for Payer: Quartz Medicare Advantage |
$3,817.01
|
| Rate for Payer: The Alliance Commercial |
$3,180.84
|
| Rate for Payer: WEA Trust Commercial |
$3,498.92
|
| Rate for Payer: WPS Commercial |
$4,711.93
|
|
|
PROBE INCREMENTING 8225825
|
Facility
|
IP
|
$2,390.00
|
|
| Hospital Charge Code |
2965311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,217.94 |
| Max. Negotiated Rate |
$2,286.75 |
| Rate for Payer: Aetna Commercial |
$2,237.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,137.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,317.37
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$2,286.75
|
| Rate for Payer: Health EOS Commercial |
$2,212.18
|
| Rate for Payer: HFN Commercial |
$2,286.75
|
| Rate for Payer: Multiplan Commercial |
$1,988.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,286.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,217.94
|
| Rate for Payer: Quartz Commercial |
$1,491.36
|
| Rate for Payer: WEA Trust Commercial |
$1,367.08
|
| Rate for Payer: WPS Commercial |
$1,841.02
|
|
|
PROBE INCREMENTING 8225825
|
Facility
|
OP
|
$2,390.00
|
|
| Hospital Charge Code |
2965311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.97 |
| Max. Negotiated Rate |
$2,286.75 |
| Rate for Payer: Aetna Commercial |
$2,237.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,137.62
|
| Rate for Payer: Aetna Managed Medicare |
$695.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,615.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,242.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,193.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,317.37
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$2,286.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,390.98
|
| Rate for Payer: Health EOS Commercial |
$2,212.18
|
| Rate for Payer: HFN Commercial |
$2,286.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,864.20
|
| Rate for Payer: Multiplan Commercial |
$1,988.48
|
| Rate for Payer: NAPHCARE Commercial |
$1,491.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,286.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,217.94
|
| Rate for Payer: Quartz Commercial |
$1,615.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,491.36
|
| Rate for Payer: The Alliance Commercial |
$1,242.80
|
| Rate for Payer: WEA Trust Commercial |
$1,367.08
|
| Rate for Payer: WPS Commercial |
$1,841.02
|
|
|
PROBE LACRIMAL CANALICULI W/WO IRRIGATION 6884050
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
CPT 68840 50
|
| Hospital Charge Code |
6174918
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.39 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna Commercial |
$1,070.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$968.64
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cigna Commercial |
$1,070.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.79
|
| Rate for Payer: Health EOS Commercial |
$1,024.95
|
| Rate for Payer: HFN Commercial |
$1,070.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$408.05
|
| Rate for Payer: Multiplan Commercial |
$901.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$495.58
|
| Rate for Payer: Quartz Commercial |
$642.00
|
| Rate for Payer: The Alliance Commercial |
$563.16
|
| Rate for Payer: United Healthcare Medicaid |
$66.39
|
| Rate for Payer: WEA Trust Commercial |
$619.48
|
| Rate for Payer: WPS Commercial |
$834.23
|
|
|
PROBE LAPAROSCOPIC ABC WITH HAND SWITCH 5MM (ARGON BEAM COAGULATOR) 160636
|
Facility
|
OP
|
$2,143.00
|
|
| Hospital Charge Code |
5496703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.04 |
| Max. Negotiated Rate |
$2,050.42 |
| Rate for Payer: Aetna Commercial |
$2,005.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,916.70
|
| Rate for Payer: Aetna Managed Medicare |
$624.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,448.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,114.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,069.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,181.22
|
| Rate for Payer: Cash Price |
$642.90
|
| Rate for Payer: Cigna Commercial |
$2,050.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,247.23
|
| Rate for Payer: Health EOS Commercial |
$1,983.56
|
| Rate for Payer: HFN Commercial |
$2,050.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,671.54
|
| Rate for Payer: Multiplan Commercial |
$1,782.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,337.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,050.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.07
|
| Rate for Payer: Quartz Commercial |
$1,448.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,337.23
|
| Rate for Payer: The Alliance Commercial |
$1,114.36
|
| Rate for Payer: WEA Trust Commercial |
$1,225.80
|
| Rate for Payer: WPS Commercial |
$1,650.75
|
|
|
PROBE LAPAROSCOPIC ABC WITH HAND SWITCH 5MM (ARGON BEAM COAGULATOR) 160636
|
Facility
|
IP
|
$2,143.00
|
|
| Hospital Charge Code |
5496703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,092.07 |
| Max. Negotiated Rate |
$2,050.42 |
| Rate for Payer: Aetna Commercial |
$2,005.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,916.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,181.22
|
| Rate for Payer: Cash Price |
$642.90
|
| Rate for Payer: Cigna Commercial |
$2,050.42
|
| Rate for Payer: Health EOS Commercial |
$1,983.56
|
| Rate for Payer: HFN Commercial |
$2,050.42
|
| Rate for Payer: Multiplan Commercial |
$1,782.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,050.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.07
|
| Rate for Payer: Quartz Commercial |
$1,337.23
|
| Rate for Payer: WEA Trust Commercial |
$1,225.80
|
| Rate for Payer: WPS Commercial |
$1,650.75
|
|
|
PROBE LOCALIZER SURGICAL HB110 & KIT INSTRUMENT COVER LOCALIZER REF 1080
|
Facility
|
IP
|
$2,591.00
|
|
| Hospital Charge Code |
6172207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.37 |
| Max. Negotiated Rate |
$2,479.07 |
| Rate for Payer: Aetna Commercial |
$2,425.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.16
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,479.07
|
| Rate for Payer: Health EOS Commercial |
$2,398.23
|
| Rate for Payer: HFN Commercial |
$2,479.07
|
| Rate for Payer: Multiplan Commercial |
$2,155.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.37
|
| Rate for Payer: Quartz Commercial |
$1,616.78
|
| Rate for Payer: WEA Trust Commercial |
$1,482.05
|
| Rate for Payer: WPS Commercial |
$1,995.85
|
|
|
PROBE LOCALIZER SURGICAL HB110 & KIT INSTRUMENT COVER LOCALIZER REF 1080
|
Facility
|
OP
|
$2,591.00
|
|
| Hospital Charge Code |
6172207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,479.07 |
| Rate for Payer: Aetna Commercial |
$2,425.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.39
|
| Rate for Payer: Aetna Managed Medicare |
$754.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,751.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,347.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,293.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.16
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,479.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,507.96
|
| Rate for Payer: Health EOS Commercial |
$2,398.23
|
| Rate for Payer: HFN Commercial |
$2,479.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,020.98
|
| Rate for Payer: Multiplan Commercial |
$2,155.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,616.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.37
|
| Rate for Payer: Quartz Commercial |
$1,751.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,616.78
|
| Rate for Payer: The Alliance Commercial |
$1,347.32
|
| Rate for Payer: WEA Trust Commercial |
$1,482.05
|
| Rate for Payer: WPS Commercial |
$1,995.85
|
|
|
PROBE NASOLACRIMAL DUCT 68815
|
Professional
|
Both
|
$1,173.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
3015258
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$1,158.92 |
| Rate for Payer: Aetna Commercial |
$1,158.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,049.13
|
| Rate for Payer: Aetna Managed Medicare |
$191.44
|
| Rate for Payer: Anthem Medicare Advantage |
$191.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$191.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$191.44
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna Commercial |
$1,158.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.44
|
| Rate for Payer: Health EOS Commercial |
$1,110.13
|
| Rate for Payer: HFN Commercial |
$1,158.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$774.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$191.44
|
| Rate for Payer: Multiplan Commercial |
$975.94
|
| Rate for Payer: NAPHCARE Commercial |
$287.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,158.92
|
| Rate for Payer: Quartz Beloit One Network |
$536.76
|
| Rate for Payer: Quartz Commercial |
$695.35
|
| Rate for Payer: Quartz Medicare Advantage |
$191.44
|
| Rate for Payer: The Alliance Commercial |
$813.63
|
| Rate for Payer: United Healthcare Medicaid |
$238.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.44
|
| Rate for Payer: WEA Trust Commercial |
$670.96
|
| Rate for Payer: WPS Commercial |
$861.49
|
|
|
PROBE NASOLACRIMAL DUCT W/WO IRRIGATION, BILAT 6881050
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
CPT 68810 50
|
| Hospital Charge Code |
6187258
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$959.35 |
| Rate for Payer: Aetna Commercial |
$959.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$959.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.90
|
| Rate for Payer: Health EOS Commercial |
$918.95
|
| Rate for Payer: HFN Commercial |
$959.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$445.94
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$959.35
|
| Rate for Payer: Quartz Beloit One Network |
$444.33
|
| Rate for Payer: Quartz Commercial |
$575.61
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: United Healthcare Medicaid |
$85.32
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
PROBE PNEUMATIC 1.0MM X 570MM LITHOCLAST M0068407330
|
Facility
|
IP
|
$2,462.00
|
|
| Hospital Charge Code |
5349058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,254.64 |
| Max. Negotiated Rate |
$2,355.64 |
| Rate for Payer: Aetna Commercial |
$2,304.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,202.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,357.05
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,355.64
|
| Rate for Payer: Health EOS Commercial |
$2,278.83
|
| Rate for Payer: HFN Commercial |
$2,355.64
|
| Rate for Payer: Multiplan Commercial |
$2,048.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,355.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,254.64
|
| Rate for Payer: Quartz Commercial |
$1,536.29
|
| Rate for Payer: WEA Trust Commercial |
$1,408.26
|
| Rate for Payer: WPS Commercial |
$1,896.48
|
|
|
PROBE PNEUMATIC 1.0MM X 570MM LITHOCLAST M0068407330
|
Facility
|
OP
|
$2,462.00
|
|
| Hospital Charge Code |
5349058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.93 |
| Max. Negotiated Rate |
$2,355.64 |
| Rate for Payer: Aetna Commercial |
$2,304.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,202.01
|
| Rate for Payer: Aetna Managed Medicare |
$716.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,664.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,229.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,357.05
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,355.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,432.88
|
| Rate for Payer: Health EOS Commercial |
$2,278.83
|
| Rate for Payer: HFN Commercial |
$2,355.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,920.36
|
| Rate for Payer: Multiplan Commercial |
$2,048.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,536.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,355.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,254.64
|
| Rate for Payer: Quartz Commercial |
$1,664.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,536.29
|
| Rate for Payer: The Alliance Commercial |
$1,280.24
|
| Rate for Payer: WEA Trust Commercial |
$1,408.26
|
| Rate for Payer: WPS Commercial |
$1,896.48
|
|
|
PROBE QUICKSILVER 10FR 350CM BCP-10AX
|
Facility
|
IP
|
$3,102.00
|
|
| Hospital Charge Code |
3295463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,580.78 |
| Max. Negotiated Rate |
$2,967.99 |
| Rate for Payer: Aetna Commercial |
$2,903.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,774.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,709.82
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$2,967.99
|
| Rate for Payer: Health EOS Commercial |
$2,871.21
|
| Rate for Payer: HFN Commercial |
$2,967.99
|
| Rate for Payer: Multiplan Commercial |
$2,580.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,967.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,580.78
|
| Rate for Payer: Quartz Commercial |
$1,935.65
|
| Rate for Payer: WEA Trust Commercial |
$1,774.34
|
| Rate for Payer: WPS Commercial |
$2,389.47
|
|
|
PROBE QUICKSILVER 10FR 350CM BCP-10AX
|
Facility
|
OP
|
$3,102.00
|
|
| Hospital Charge Code |
3295463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$903.30 |
| Max. Negotiated Rate |
$2,967.99 |
| Rate for Payer: Aetna Commercial |
$2,903.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,774.43
|
| Rate for Payer: Aetna Managed Medicare |
$903.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,096.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,613.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,548.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,709.82
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$2,967.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,805.36
|
| Rate for Payer: Health EOS Commercial |
$2,871.21
|
| Rate for Payer: HFN Commercial |
$2,967.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,419.56
|
| Rate for Payer: Multiplan Commercial |
$2,580.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,935.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,967.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,580.78
|
| Rate for Payer: Quartz Commercial |
$2,096.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,935.65
|
| Rate for Payer: The Alliance Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,774.34
|
| Rate for Payer: WPS Commercial |
$2,389.47
|
|
