|
Athrec/Stent/PTA Tib/Peroneal
|
Facility
OP
|
$10,527.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
3052452
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,158.23 |
| Max. Negotiated Rate |
$64,474.41 |
| Rate for Payer: Aetna Commercial |
$9,474.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,053.22
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,579.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cigna Commercial |
$9,684.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$9,369.03
|
| Rate for Payer: HFN Commercial |
$9,684.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$8,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,684.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,158.23
|
| Rate for Payer: Quartz Commercial |
$6,842.55
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$5,789.85
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$7,797.35
|
|
|
Athrec/Stent/PTA Tib/Peroneal
|
Facility
IP
|
$10,527.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
3052452
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,158.23 |
| Max. Negotiated Rate |
$9,684.84 |
| Rate for Payer: Aetna Commercial |
$9,474.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,579.31
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cigna Commercial |
$9,684.84
|
| Rate for Payer: Health EOS Commercial |
$9,369.03
|
| Rate for Payer: HFN Commercial |
$9,684.84
|
| Rate for Payer: Multiplan Commercial |
$8,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,316.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,684.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,158.23
|
| Rate for Payer: Quartz Commercial |
$6,316.20
|
| Rate for Payer: WEA Trust Commercial |
$5,789.85
|
| Rate for Payer: WPS Commercial |
$7,797.35
|
|
|
Athrectomy Fem/Pop incl PTA
|
Facility
IP
|
$9,110.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
3052446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,463.90 |
| Max. Negotiated Rate |
$8,381.20 |
| Rate for Payer: Aetna Commercial |
$8,199.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,828.30
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cigna Commercial |
$8,381.20
|
| Rate for Payer: Health EOS Commercial |
$8,107.90
|
| Rate for Payer: HFN Commercial |
$8,381.20
|
| Rate for Payer: Multiplan Commercial |
$7,288.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,466.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,381.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,463.90
|
| Rate for Payer: Quartz Commercial |
$5,466.00
|
| Rate for Payer: WEA Trust Commercial |
$5,010.50
|
| Rate for Payer: WPS Commercial |
$6,747.78
|
|
|
Athrectomy Fem/Pop incl PTA
|
Facility
OP
|
$9,110.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
3052446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,463.90 |
| Max. Negotiated Rate |
$64,474.41 |
| Rate for Payer: Aetna Commercial |
$8,199.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,834.60
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,828.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cigna Commercial |
$8,381.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$8,107.90
|
| Rate for Payer: HFN Commercial |
$8,381.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$7,288.00
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,381.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,463.90
|
| Rate for Payer: Quartz Commercial |
$5,921.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$5,010.50
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$6,747.78
|
|
|
Athrectomy Jetstream
|
Professional
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,912.24 |
| Max. Negotiated Rate |
$4,128.70 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,128.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,607.60
|
| Rate for Payer: Health EOS Commercial |
$3,954.86
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,128.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,912.24
|
| Rate for Payer: Quartz Commercial |
$2,477.22
|
| Rate for Payer: The Alliance Commercial |
$2,173.00
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Athrectomy Jetstream
|
Facility
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$3,998.32 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,216.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,824.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,086.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,432.02
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,259.50
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,824.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,607.60
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Athrectomy Jetstream
|
Facility
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,129.54 |
| Max. Negotiated Rate |
$3,998.32 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,607.60
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Athrectomy Tib/Peroneal Incl PTA
|
Facility
IP
|
$8,966.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
3052450
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,393.34 |
| Max. Negotiated Rate |
$8,248.72 |
| Rate for Payer: Aetna Commercial |
$8,069.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,751.98
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cigna Commercial |
$8,248.72
|
| Rate for Payer: Health EOS Commercial |
$7,979.74
|
| Rate for Payer: HFN Commercial |
$8,248.72
|
| Rate for Payer: Multiplan Commercial |
$7,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,379.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,248.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,393.34
|
| Rate for Payer: Quartz Commercial |
$5,379.60
|
| Rate for Payer: WEA Trust Commercial |
$4,931.30
|
| Rate for Payer: WPS Commercial |
$6,641.12
|
|
|
Athrectomy Tib/Peroneal Incl PTA
|
Facility
OP
|
$8,966.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
3052450
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,393.34 |
| Max. Negotiated Rate |
$64,474.41 |
| Rate for Payer: Aetna Commercial |
$8,069.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,710.76
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,751.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cigna Commercial |
$8,248.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$7,979.74
|
| Rate for Payer: HFN Commercial |
$8,248.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$7,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,248.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,393.34
|
| Rate for Payer: Quartz Commercial |
$5,827.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$4,931.30
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$6,641.12
|
|
|
Ativan 2 mg Charge
|
Professional
|
$34.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2958974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Aetna Managed Medicare |
$0.85
|
| Rate for Payer: Anthem Medicare Advantage |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.85
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$30.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Preferred Network Access Commercial |
$32.30
|
| Rate for Payer: Quartz Beloit One Network |
$14.96
|
| Rate for Payer: Quartz Commercial |
$19.38
|
| Rate for Payer: Quartz Medicare Advantage |
$0.85
|
| Rate for Payer: The Alliance Commercial |
$2.34
|
| Rate for Payer: United Healthcare Medicaid |
$0.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.85
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$2.40
|
|
|
Ativan 2 mg Charge
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2958974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$490,002.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Aetna Managed Medicare |
$9.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.27
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$22.10
|
| Rate for Payer: Quartz Medicare Advantage |
$20.40
|
| Rate for Payer: The Alliance Commercial |
$490,002.00
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$2.40
|
|
|
Ativan 2 mg Charge
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2958974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$20.40
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
ATOMIC EDGE KNIFE 600 MICRON 370260
|
Facility
OP
|
$701.00
|
|
| Hospital Charge Code |
5415298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.28 |
| Max. Negotiated Rate |
$2,804.00 |
| Rate for Payer: Aetna Commercial |
$630.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.86
|
| Rate for Payer: Aetna Managed Medicare |
$196.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$455.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$350.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.53
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$644.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.28
|
| Rate for Payer: Health EOS Commercial |
$623.89
|
| Rate for Payer: HFN Commercial |
$644.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.75
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: NAPHCARE Commercial |
$420.60
|
| Rate for Payer: Preferred Network Access Commercial |
$644.92
|
| Rate for Payer: Quartz Beloit One Network |
$343.49
|
| Rate for Payer: Quartz Commercial |
$455.65
|
| Rate for Payer: Quartz Medicare Advantage |
$420.60
|
| Rate for Payer: The Alliance Commercial |
$2,804.00
|
| Rate for Payer: WEA Trust Commercial |
$385.55
|
| Rate for Payer: WPS Commercial |
$519.23
|
|
|
ATOMIC EDGE KNIFE 600 MICRON 370260
|
Facility
IP
|
$701.00
|
|
| Hospital Charge Code |
5415298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.49 |
| Max. Negotiated Rate |
$644.92 |
| Rate for Payer: Aetna Commercial |
$630.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.53
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$644.92
|
| Rate for Payer: Health EOS Commercial |
$623.89
|
| Rate for Payer: HFN Commercial |
$644.92
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: NAPHCARE Commercial |
$420.60
|
| Rate for Payer: Preferred Network Access Commercial |
$644.92
|
| Rate for Payer: Quartz Beloit One Network |
$343.49
|
| Rate for Payer: Quartz Commercial |
$420.60
|
| Rate for Payer: WEA Trust Commercial |
$385.55
|
| Rate for Payer: WPS Commercial |
$519.23
|
|
|
Atomoxetine, Serum
|
Facility
IP
|
$417.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3674168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$204.33 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$250.20
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Atomoxetine, Serum
|
Professional
|
$417.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3674168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Aetna Commercial |
$396.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$396.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.20
|
| Rate for Payer: Health EOS Commercial |
$379.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.15
|
| Rate for Payer: Quartz Beloit One Network |
$183.48
|
| Rate for Payer: Quartz Commercial |
$237.69
|
| Rate for Payer: The Alliance Commercial |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Atomoxetine, Serum
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3674168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Aetna Managed Medicare |
$116.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$271.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$271.05
|
| Rate for Payer: Quartz Medicare Advantage |
$250.20
|
| Rate for Payer: United Healthcare PPO |
$312.75
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
ATRIAL SEPTAL DEFECT
|
Facility
OP
|
$15,894.00
|
|
| Hospital Charge Code |
4494606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,450.32 |
| Max. Negotiated Rate |
$63,576.00 |
| Rate for Payer: Aetna Commercial |
$14,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,668.84
|
| Rate for Payer: Aetna Managed Medicare |
$4,450.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,331.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,947.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,629.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,423.82
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$14,622.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,894.28
|
| Rate for Payer: Health EOS Commercial |
$14,145.66
|
| Rate for Payer: HFN Commercial |
$14,622.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,920.50
|
| Rate for Payer: Multiplan Commercial |
$12,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,622.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,788.06
|
| Rate for Payer: Quartz Commercial |
$10,331.10
|
| Rate for Payer: Quartz Medicare Advantage |
$9,536.40
|
| Rate for Payer: The Alliance Commercial |
$63,576.00
|
| Rate for Payer: WEA Trust Commercial |
$8,741.70
|
| Rate for Payer: WPS Commercial |
$11,772.69
|
|
|
ATRIAL SEPTAL DEFECT
|
Facility
IP
|
$15,894.00
|
|
| Hospital Charge Code |
4494606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,788.06 |
| Max. Negotiated Rate |
$14,622.48 |
| Rate for Payer: Aetna Commercial |
$14,304.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,423.82
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$14,622.48
|
| Rate for Payer: Health EOS Commercial |
$14,145.66
|
| Rate for Payer: HFN Commercial |
$14,622.48
|
| Rate for Payer: Multiplan Commercial |
$12,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,622.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,788.06
|
| Rate for Payer: Quartz Commercial |
$9,536.40
|
| Rate for Payer: WEA Trust Commercial |
$8,741.70
|
| Rate for Payer: WPS Commercial |
$11,772.69
|
|
|
ATRICLIP 35MM LAA EXCLUSION FLEX HANDLE ACH235
|
Facility
OP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,214.96 |
| Max. Negotiated Rate |
$10,563.44 |
| Rate for Payer: Aetna Commercial |
$10,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,874.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,214.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,463.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,085.46
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,563.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,425.33
|
| Rate for Payer: Health EOS Commercial |
$10,218.98
|
| Rate for Payer: HFN Commercial |
$10,563.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,611.50
|
| Rate for Payer: Multiplan Commercial |
$9,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,563.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,626.18
|
| Rate for Payer: Quartz Commercial |
$7,463.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,889.20
|
| Rate for Payer: WEA Trust Commercial |
$6,315.10
|
| Rate for Payer: WPS Commercial |
$8,504.72
|
|
|
ATRICLIP 35MM LAA EXCLUSION FLEX HANDLE ACH235
|
Facility
IP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,626.18 |
| Max. Negotiated Rate |
$10,563.44 |
| Rate for Payer: Aetna Commercial |
$10,333.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,085.46
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,563.44
|
| Rate for Payer: Health EOS Commercial |
$10,218.98
|
| Rate for Payer: HFN Commercial |
$10,563.44
|
| Rate for Payer: Multiplan Commercial |
$9,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,563.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,626.18
|
| Rate for Payer: Quartz Commercial |
$6,889.20
|
| Rate for Payer: WEA Trust Commercial |
$6,315.10
|
| Rate for Payer: WPS Commercial |
$8,504.72
|
|
|
ATRICLIP 40MM LAA EXCLUSION FLEX HANDLE ACH240
|
Facility
IP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,626.18 |
| Max. Negotiated Rate |
$10,563.44 |
| Rate for Payer: Aetna Commercial |
$10,333.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,085.46
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,563.44
|
| Rate for Payer: Health EOS Commercial |
$10,218.98
|
| Rate for Payer: HFN Commercial |
$10,563.44
|
| Rate for Payer: Multiplan Commercial |
$9,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,563.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,626.18
|
| Rate for Payer: Quartz Commercial |
$6,889.20
|
| Rate for Payer: WEA Trust Commercial |
$6,315.10
|
| Rate for Payer: WPS Commercial |
$8,504.72
|
|
|
ATRICLIP 40MM LAA EXCLUSION FLEX HANDLE ACH240
|
Facility
OP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,214.96 |
| Max. Negotiated Rate |
$10,563.44 |
| Rate for Payer: Aetna Commercial |
$10,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,874.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,214.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,463.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,085.46
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,563.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,425.33
|
| Rate for Payer: Health EOS Commercial |
$10,218.98
|
| Rate for Payer: HFN Commercial |
$10,563.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,611.50
|
| Rate for Payer: Multiplan Commercial |
$9,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,563.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,626.18
|
| Rate for Payer: Quartz Commercial |
$7,463.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,889.20
|
| Rate for Payer: WEA Trust Commercial |
$6,315.10
|
| Rate for Payer: WPS Commercial |
$8,504.72
|
|
|
ATRICLIP 40MM LAA FLEX V ACHV40
|
Facility
OP
|
$9,717.00
|
|
| Hospital Charge Code |
5685744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,720.76 |
| Max. Negotiated Rate |
$38,868.00 |
| Rate for Payer: Aetna Commercial |
$8,745.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,356.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,720.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,316.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,858.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,664.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,150.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$8,939.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,437.63
|
| Rate for Payer: Health EOS Commercial |
$8,648.13
|
| Rate for Payer: HFN Commercial |
$8,939.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,287.75
|
| Rate for Payer: Multiplan Commercial |
$7,773.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,830.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,939.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,761.33
|
| Rate for Payer: Quartz Commercial |
$6,316.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,830.20
|
| Rate for Payer: The Alliance Commercial |
$38,868.00
|
| Rate for Payer: WEA Trust Commercial |
$5,344.35
|
| Rate for Payer: WPS Commercial |
$7,197.38
|
|
|
ATRICLIP 40MM LAA FLEX V ACHV40
|
Facility
IP
|
$9,717.00
|
|
| Hospital Charge Code |
5685744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,761.33 |
| Max. Negotiated Rate |
$8,939.64 |
| Rate for Payer: Aetna Commercial |
$8,745.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,150.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$8,939.64
|
| Rate for Payer: Health EOS Commercial |
$8,648.13
|
| Rate for Payer: HFN Commercial |
$8,939.64
|
| Rate for Payer: Multiplan Commercial |
$7,773.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,830.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,939.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,761.33
|
| Rate for Payer: Quartz Commercial |
$5,830.20
|
| Rate for Payer: WEA Trust Commercial |
$5,344.35
|
| Rate for Payer: WPS Commercial |
$7,197.38
|
|
