|
PROBE BILIARY BALLOON 6 FRENCH
|
Facility
|
OP
|
$1,129.00
|
|
| Hospital Charge Code |
2963299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.12 |
| Max. Negotiated Rate |
$4,516.00 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.94
|
| Rate for Payer: Aetna Managed Medicare |
$316.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$733.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$564.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.37
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,038.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$631.79
|
| Rate for Payer: Health EOS Commercial |
$1,004.81
|
| Rate for Payer: HFN Commercial |
$1,038.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$846.75
|
| Rate for Payer: Multiplan Commercial |
$903.20
|
| Rate for Payer: NAPHCARE Commercial |
$677.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,038.68
|
| Rate for Payer: Quartz Beloit One Network |
$553.21
|
| Rate for Payer: Quartz Commercial |
$733.85
|
| Rate for Payer: Quartz Medicare Advantage |
$677.40
|
| Rate for Payer: The Alliance Commercial |
$4,516.00
|
| Rate for Payer: WEA Trust Commercial |
$620.95
|
| Rate for Payer: WPS Commercial |
$836.25
|
|
|
PROBE BILIARY BALLOON 6 FRENCH
|
Facility
|
IP
|
$1,129.00
|
|
| Hospital Charge Code |
2963299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.21 |
| Max. Negotiated Rate |
$1,038.68 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.37
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,038.68
|
| Rate for Payer: Health EOS Commercial |
$1,004.81
|
| Rate for Payer: HFN Commercial |
$1,038.68
|
| Rate for Payer: Multiplan Commercial |
$903.20
|
| Rate for Payer: NAPHCARE Commercial |
$677.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,038.68
|
| Rate for Payer: Quartz Beloit One Network |
$553.21
|
| Rate for Payer: Quartz Commercial |
$677.40
|
| Rate for Payer: WEA Trust Commercial |
$620.95
|
| Rate for Payer: WPS Commercial |
$836.25
|
|
|
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 |
$644.00 |
| Max. Negotiated Rate |
$9,200.00 |
| Rate for Payer: Aetna Commercial |
$2,070.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.00
|
| Rate for Payer: Aetna Managed Medicare |
$644.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,495.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$2,116.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,287.08
|
| Rate for Payer: Health EOS Commercial |
$2,047.00
|
| Rate for Payer: HFN Commercial |
$2,116.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.00
|
| Rate for Payer: Quartz Commercial |
$1,495.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,380.00
|
| Rate for Payer: The Alliance Commercial |
$9,200.00
|
| Rate for Payer: WEA Trust Commercial |
$1,265.00
|
| Rate for Payer: WPS Commercial |
$1,703.61
|
|
|
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 |
$1,127.00 |
| Max. Negotiated Rate |
$2,116.00 |
| Rate for Payer: Aetna Commercial |
$2,070.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$2,116.00
|
| Rate for Payer: Health EOS Commercial |
$2,047.00
|
| Rate for Payer: HFN Commercial |
$2,116.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.00
|
| Rate for Payer: Quartz Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$1,265.00
|
| Rate for Payer: WPS Commercial |
$1,703.61
|
|
|
PROBE CRYO-ABLATION 20MM CRYO2
|
Facility
|
OP
|
$15,713.00
|
|
| Hospital Charge Code |
2964755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,399.64 |
| Max. Negotiated Rate |
$62,852.00 |
| Rate for Payer: Aetna Commercial |
$14,141.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,399.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,213.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,856.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,542.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,327.89
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$14,455.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,792.99
|
| Rate for Payer: Health EOS Commercial |
$13,984.57
|
| Rate for Payer: HFN Commercial |
$14,455.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,784.75
|
| Rate for Payer: Multiplan Commercial |
$12,570.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,427.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,455.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.37
|
| Rate for Payer: Quartz Commercial |
$10,213.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,427.80
|
| Rate for Payer: The Alliance Commercial |
$62,852.00
|
| Rate for Payer: WEA Trust Commercial |
$8,642.15
|
| Rate for Payer: WPS Commercial |
$11,638.62
|
|
|
PROBE CRYO-ABLATION 20MM CRYO2
|
Facility
|
IP
|
$15,713.00
|
|
| Hospital Charge Code |
2964755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,699.37 |
| Max. Negotiated Rate |
$14,455.96 |
| Rate for Payer: Aetna Commercial |
$14,141.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,327.89
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$14,455.96
|
| Rate for Payer: Health EOS Commercial |
$13,984.57
|
| Rate for Payer: HFN Commercial |
$14,455.96
|
| Rate for Payer: Multiplan Commercial |
$12,570.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,427.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,455.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.37
|
| Rate for Payer: Quartz Commercial |
$9,427.80
|
| Rate for Payer: WEA Trust Commercial |
$8,642.15
|
| Rate for Payer: WPS Commercial |
$11,638.62
|
|
|
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 |
$2,997.33 |
| Max. Negotiated Rate |
$5,627.64 |
| Rate for Payer: Aetna Commercial |
$5,505.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,260.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.01
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,627.64
|
| Rate for Payer: Health EOS Commercial |
$5,444.13
|
| Rate for Payer: HFN Commercial |
$5,627.64
|
| Rate for Payer: Multiplan Commercial |
$4,893.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,627.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.33
|
| Rate for Payer: Quartz Commercial |
$3,670.20
|
| Rate for Payer: WEA Trust Commercial |
$3,364.35
|
| Rate for Payer: WPS Commercial |
$4,530.86
|
|
|
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 |
$1,712.76 |
| Max. Negotiated Rate |
$24,468.00 |
| Rate for Payer: Aetna Commercial |
$5,505.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,260.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,712.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,976.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,058.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,936.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.01
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,627.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,423.07
|
| Rate for Payer: Health EOS Commercial |
$5,444.13
|
| Rate for Payer: HFN Commercial |
$5,627.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,587.75
|
| Rate for Payer: Multiplan Commercial |
$4,893.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,627.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.33
|
| Rate for Payer: Quartz Commercial |
$3,976.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,670.20
|
| Rate for Payer: The Alliance Commercial |
$24,468.00
|
| Rate for Payer: WEA Trust Commercial |
$3,364.35
|
| Rate for Payer: WPS Commercial |
$4,530.86
|
|
|
PROBE INCREMENTING 8225825
|
Facility
|
IP
|
$2,390.00
|
|
| Hospital Charge Code |
2965311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,171.10 |
| Max. Negotiated Rate |
$2,198.80 |
| Rate for Payer: Aetna Commercial |
$2,151.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,055.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.70
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$2,198.80
|
| Rate for Payer: Health EOS Commercial |
$2,127.10
|
| Rate for Payer: HFN Commercial |
$2,198.80
|
| Rate for Payer: Multiplan Commercial |
$1,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,434.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,198.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,171.10
|
| Rate for Payer: Quartz Commercial |
$1,434.00
|
| Rate for Payer: WEA Trust Commercial |
$1,314.50
|
| Rate for Payer: WPS Commercial |
$1,770.27
|
|
|
PROBE INCREMENTING 8225825
|
Facility
|
OP
|
$2,390.00
|
|
| Hospital Charge Code |
2965311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$9,560.00 |
| Rate for Payer: Aetna Commercial |
$2,151.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,055.40
|
| Rate for Payer: Aetna Managed Medicare |
$669.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,553.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,147.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.70
|
| Rate for Payer: Cash Price |
$717.00
|
| Rate for Payer: Cigna Commercial |
$2,198.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,337.44
|
| Rate for Payer: Health EOS Commercial |
$2,127.10
|
| Rate for Payer: HFN Commercial |
$2,198.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,792.50
|
| Rate for Payer: Multiplan Commercial |
$1,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,434.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,198.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,171.10
|
| Rate for Payer: Quartz Commercial |
$1,553.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,434.00
|
| Rate for Payer: The Alliance Commercial |
$9,560.00
|
| Rate for Payer: WEA Trust Commercial |
$1,314.50
|
| Rate for Payer: WPS Commercial |
$1,770.27
|
|
|
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 |
$63.84 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Aetna Commercial |
$1,028.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$931.38
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cigna Commercial |
$1,028.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.80
|
| Rate for Payer: Health EOS Commercial |
$985.53
|
| Rate for Payer: HFN Commercial |
$1,028.85
|
| Rate for Payer: Multiplan Commercial |
$866.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,028.85
|
| Rate for Payer: Quartz Beloit One Network |
$476.52
|
| Rate for Payer: Quartz Commercial |
$617.31
|
| Rate for Payer: The Alliance Commercial |
$541.50
|
| Rate for Payer: United Healthcare Medicaid |
$63.84
|
| Rate for Payer: WEA Trust Commercial |
$595.65
|
| Rate for Payer: WPS Commercial |
$802.18
|
|
|
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 |
$1,050.07 |
| Max. Negotiated Rate |
$1,971.56 |
| Rate for Payer: Aetna Commercial |
$1,928.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,842.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,135.79
|
| Rate for Payer: Cash Price |
$642.90
|
| Rate for Payer: Cigna Commercial |
$1,971.56
|
| Rate for Payer: Health EOS Commercial |
$1,907.27
|
| Rate for Payer: HFN Commercial |
$1,971.56
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,285.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,971.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,050.07
|
| Rate for Payer: Quartz Commercial |
$1,285.80
|
| Rate for Payer: WEA Trust Commercial |
$1,178.65
|
| Rate for Payer: WPS Commercial |
$1,587.32
|
|
|
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 |
$600.04 |
| Max. Negotiated Rate |
$8,572.00 |
| Rate for Payer: Aetna Commercial |
$1,928.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,842.98
|
| Rate for Payer: Aetna Managed Medicare |
$600.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,392.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,071.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,028.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,135.79
|
| Rate for Payer: Cash Price |
$642.90
|
| Rate for Payer: Cigna Commercial |
$1,971.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,199.22
|
| Rate for Payer: Health EOS Commercial |
$1,907.27
|
| Rate for Payer: HFN Commercial |
$1,971.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,607.25
|
| Rate for Payer: Multiplan Commercial |
$1,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,285.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,971.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,050.07
|
| Rate for Payer: Quartz Commercial |
$1,392.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,285.80
|
| Rate for Payer: The Alliance Commercial |
$8,572.00
|
| Rate for Payer: WEA Trust Commercial |
$1,178.65
|
| Rate for Payer: WPS Commercial |
$1,587.32
|
|
|
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 |
$725.48 |
| Max. Negotiated Rate |
$10,364.00 |
| Rate for Payer: Aetna Commercial |
$2,331.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.26
|
| Rate for Payer: Aetna Managed Medicare |
$725.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,684.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,243.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.23
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,383.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,449.92
|
| Rate for Payer: Health EOS Commercial |
$2,305.99
|
| Rate for Payer: HFN Commercial |
$2,383.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,943.25
|
| Rate for Payer: Multiplan Commercial |
$2,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.59
|
| Rate for Payer: Quartz Commercial |
$1,684.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,554.60
|
| Rate for Payer: The Alliance Commercial |
$10,364.00
|
| Rate for Payer: WEA Trust Commercial |
$1,425.05
|
| Rate for Payer: WPS Commercial |
$1,919.15
|
|
|
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 |
$1,269.59 |
| Max. Negotiated Rate |
$2,383.72 |
| Rate for Payer: Aetna Commercial |
$2,331.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,228.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.23
|
| Rate for Payer: Cash Price |
$777.30
|
| Rate for Payer: Cigna Commercial |
$2,383.72
|
| Rate for Payer: Health EOS Commercial |
$2,305.99
|
| Rate for Payer: HFN Commercial |
$2,383.72
|
| Rate for Payer: Multiplan Commercial |
$2,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.59
|
| Rate for Payer: Quartz Commercial |
$1,554.60
|
| Rate for Payer: WEA Trust Commercial |
$1,425.05
|
| Rate for Payer: WPS Commercial |
$1,919.15
|
|
|
PROBE NASOLACRIMAL DUCT 68815
|
Professional
|
Both
|
$1,173.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
3015258
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.70 |
| Max. Negotiated Rate |
$1,114.35 |
| Rate for Payer: Aetna Commercial |
$1,114.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,008.78
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna Commercial |
$1,114.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.80
|
| Rate for Payer: Health EOS Commercial |
$1,067.43
|
| Rate for Payer: HFN Commercial |
$1,114.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$745.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.15
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.35
|
| Rate for Payer: Quartz Beloit One Network |
$516.12
|
| Rate for Payer: Quartz Commercial |
$668.61
|
| Rate for Payer: The Alliance Commercial |
$586.50
|
| Rate for Payer: United Healthcare Medicaid |
$229.70
|
| Rate for Payer: WEA Trust Commercial |
$645.15
|
| Rate for Payer: WPS Commercial |
$868.84
|
|
|
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 |
$82.04 |
| Max. Negotiated Rate |
$922.45 |
| Rate for Payer: Aetna Commercial |
$922.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$922.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.60
|
| Rate for Payer: Health EOS Commercial |
$883.61
|
| Rate for Payer: HFN Commercial |
$922.45
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.45
|
| Rate for Payer: Quartz Beloit One Network |
$427.24
|
| Rate for Payer: Quartz Commercial |
$553.47
|
| Rate for Payer: The Alliance Commercial |
$485.50
|
| Rate for Payer: United Healthcare Medicaid |
$82.04
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
PROBE PNEUMATIC 1.0MM X 570MM LITHOCLAST M0068407330
|
Facility
|
OP
|
$2,462.00
|
|
| Hospital Charge Code |
5349058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.36 |
| Max. Negotiated Rate |
$9,848.00 |
| Rate for Payer: Aetna Commercial |
$2,215.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.32
|
| Rate for Payer: Aetna Managed Medicare |
$689.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,600.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,231.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,181.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,304.86
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,265.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,377.74
|
| Rate for Payer: Health EOS Commercial |
$2,191.18
|
| Rate for Payer: HFN Commercial |
$2,265.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,846.50
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,477.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.38
|
| Rate for Payer: Quartz Commercial |
$1,600.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,477.20
|
| Rate for Payer: The Alliance Commercial |
$9,848.00
|
| Rate for Payer: WEA Trust Commercial |
$1,354.10
|
| Rate for Payer: WPS Commercial |
$1,823.60
|
|
|
PROBE PNEUMATIC 1.0MM X 570MM LITHOCLAST M0068407330
|
Facility
|
IP
|
$2,462.00
|
|
| Hospital Charge Code |
5349058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,206.38 |
| Max. Negotiated Rate |
$2,265.04 |
| Rate for Payer: Aetna Commercial |
$2,215.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,304.86
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,265.04
|
| Rate for Payer: Health EOS Commercial |
$2,191.18
|
| Rate for Payer: HFN Commercial |
$2,265.04
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,477.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.38
|
| Rate for Payer: Quartz Commercial |
$1,477.20
|
| Rate for Payer: WEA Trust Commercial |
$1,354.10
|
| Rate for Payer: WPS Commercial |
$1,823.60
|
|
|
PROBE QUICKSILVER 10FR 350CM BCP-10AX
|
Facility
|
OP
|
$3,102.00
|
|
| Hospital Charge Code |
3295463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$868.56 |
| Max. Negotiated Rate |
$12,408.00 |
| Rate for Payer: Aetna Commercial |
$2,791.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,667.72
|
| Rate for Payer: Aetna Managed Medicare |
$868.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,016.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,488.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,644.06
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$2,853.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,735.88
|
| Rate for Payer: Health EOS Commercial |
$2,760.78
|
| Rate for Payer: HFN Commercial |
$2,853.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,326.50
|
| Rate for Payer: Multiplan Commercial |
$2,481.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,861.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,853.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.98
|
| Rate for Payer: Quartz Commercial |
$2,016.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,861.20
|
| Rate for Payer: The Alliance Commercial |
$12,408.00
|
| Rate for Payer: WEA Trust Commercial |
$1,706.10
|
| Rate for Payer: WPS Commercial |
$2,297.65
|
|
|
PROBE QUICKSILVER 10FR 350CM BCP-10AX
|
Facility
|
IP
|
$3,102.00
|
|
| Hospital Charge Code |
3295463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,519.98 |
| Max. Negotiated Rate |
$2,853.84 |
| Rate for Payer: Aetna Commercial |
$2,791.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,667.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,644.06
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$2,853.84
|
| Rate for Payer: Health EOS Commercial |
$2,760.78
|
| Rate for Payer: HFN Commercial |
$2,853.84
|
| Rate for Payer: Multiplan Commercial |
$2,481.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,861.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,853.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.98
|
| Rate for Payer: Quartz Commercial |
$1,861.20
|
| Rate for Payer: WEA Trust Commercial |
$1,706.10
|
| Rate for Payer: WPS Commercial |
$2,297.65
|
|
|
PROBE QUICKSILVER 7FR 350CM BCP-7AX
|
Facility
|
OP
|
$3,103.00
|
|
| Hospital Charge Code |
2973294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$868.84 |
| Max. Negotiated Rate |
$12,412.00 |
| Rate for Payer: Aetna Commercial |
$2,792.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,668.58
|
| Rate for Payer: Aetna Managed Medicare |
$868.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,016.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,551.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,489.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,644.59
|
| Rate for Payer: Cash Price |
$930.90
|
| Rate for Payer: Cigna Commercial |
$2,854.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,736.44
|
| Rate for Payer: Health EOS Commercial |
$2,761.67
|
| Rate for Payer: HFN Commercial |
$2,854.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,327.25
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,861.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,854.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,520.47
|
| Rate for Payer: Quartz Commercial |
$2,016.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,861.80
|
| Rate for Payer: The Alliance Commercial |
$12,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,706.65
|
| Rate for Payer: WPS Commercial |
$2,298.39
|
|
|
PROBE QUICKSILVER 7FR 350CM BCP-7AX
|
Facility
|
IP
|
$3,103.00
|
|
| Hospital Charge Code |
2973294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,520.47 |
| Max. Negotiated Rate |
$2,854.76 |
| Rate for Payer: Aetna Commercial |
$2,792.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,668.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,644.59
|
| Rate for Payer: Cash Price |
$930.90
|
| Rate for Payer: Cigna Commercial |
$2,854.76
|
| Rate for Payer: Health EOS Commercial |
$2,761.67
|
| Rate for Payer: HFN Commercial |
$2,854.76
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,861.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,854.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,520.47
|
| Rate for Payer: Quartz Commercial |
$1,861.80
|
| Rate for Payer: WEA Trust Commercial |
$1,706.65
|
| Rate for Payer: WPS Commercial |
$2,298.39
|
|
|
PROBE SET US LOCALIZER 20 09-0006 (PROBE HB110 & INSTRUMENT COVER 1080) 09-0006
|
Facility
|
IP
|
$2,695.00
|
|
| Hospital Charge Code |
6170309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.55 |
| Max. Negotiated Rate |
$2,479.40 |
| Rate for Payer: Aetna Commercial |
$2,425.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.35
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cigna Commercial |
$2,479.40
|
| Rate for Payer: Health EOS Commercial |
$2,398.55
|
| Rate for Payer: HFN Commercial |
$2,479.40
|
| Rate for Payer: Multiplan Commercial |
$2,156.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,617.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.55
|
| Rate for Payer: Quartz Commercial |
$1,617.00
|
| Rate for Payer: WEA Trust Commercial |
$1,482.25
|
| Rate for Payer: WPS Commercial |
$1,996.19
|
|
|
PROBE SET US LOCALIZER 20 09-0006 (PROBE HB110 & INSTRUMENT COVER 1080) 09-0006
|
Facility
|
OP
|
$2,695.00
|
|
| Hospital Charge Code |
6170309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.60 |
| Max. Negotiated Rate |
$10,780.00 |
| Rate for Payer: Aetna Commercial |
$2,425.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,317.70
|
| Rate for Payer: Aetna Managed Medicare |
$754.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,751.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,293.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.35
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cigna Commercial |
$2,479.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,508.12
|
| Rate for Payer: Health EOS Commercial |
$2,398.55
|
| Rate for Payer: HFN Commercial |
$2,479.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,021.25
|
| Rate for Payer: Multiplan Commercial |
$2,156.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,617.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.55
|
| Rate for Payer: Quartz Commercial |
$1,751.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,617.00
|
| Rate for Payer: The Alliance Commercial |
$10,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,482.25
|
| Rate for Payer: WPS Commercial |
$1,996.19
|
|
