|
SET HEATED INSUFFLATION TUBING/CONNECTOR ARTHREX DISPOSABLE AR-3290-1007
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
5074897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
SET NON-HEATED INSUFFLATION TUBING/CONNECTOR ARTHREX DISPOSABLE AR-3290-1001
|
Facility
|
IP
|
$684.00
|
|
| Hospital Charge Code |
5496911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.57 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
SET NON-HEATED INSUFFLATION TUBING/CONNECTOR ARTHREX DISPOSABLE AR-3290-1001
|
Facility
|
OP
|
$684.00
|
|
| Hospital Charge Code |
5496911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$199.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.09
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$533.52
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$426.82
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$426.82
|
| Rate for Payer: The Alliance Commercial |
$355.68
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
SET OUTFLOW CASSETTE/TUBING ARTHROSCOPY ARTHREX AR-6430
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
5074887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$554.11
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
SET OUTFLOW CASSETTE/TUBING ARTHROSCOPY ARTHREX AR-6430
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
5074887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.59 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Aetna Managed Medicare |
$258.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.82
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: NAPHCARE Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: Quartz Medicare Advantage |
$554.11
|
| Rate for Payer: The Alliance Commercial |
$461.76
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
SET RE-ENTRY MALECOT NEPHROSTOMY CATHETER 24F X 35CM M0064101070
|
Facility
|
IP
|
$1,234.00
|
|
| Hospital Charge Code |
5415303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
SET RE-ENTRY MALECOT NEPHROSTOMY CATHETER 24F X 35CM M0064101070
|
Facility
|
OP
|
$1,234.00
|
|
| Hospital Charge Code |
5415303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$641.68
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
SET SCREW TI 8 X 17.5MM 3003-0822S
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4120815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.43 |
| Max. Negotiated Rate |
$2,018.85 |
| Rate for Payer: Aetna Commercial |
$1,974.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.18
|
| Rate for Payer: Aetna Managed Medicare |
$614.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.03
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$2,018.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.02
|
| Rate for Payer: Health EOS Commercial |
$1,953.02
|
| Rate for Payer: HFN Commercial |
$2,018.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,645.80
|
| Rate for Payer: Multiplan Commercial |
$1,755.52
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.26
|
| Rate for Payer: Quartz Commercial |
$1,426.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,316.64
|
| Rate for Payer: The Alliance Commercial |
$1,097.20
|
| Rate for Payer: WEA Trust Commercial |
$1,206.92
|
| Rate for Payer: WPS Commercial |
$1,625.33
|
|
|
SET SCREW TI 8 X 17.5MM 3003-0822S
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4120815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.26 |
| Max. Negotiated Rate |
$2,018.85 |
| Rate for Payer: Aetna Commercial |
$1,974.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.03
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$2,018.85
|
| Rate for Payer: Health EOS Commercial |
$1,953.02
|
| Rate for Payer: HFN Commercial |
$2,018.85
|
| Rate for Payer: Multiplan Commercial |
$1,755.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.26
|
| Rate for Payer: Quartz Commercial |
$1,316.64
|
| Rate for Payer: WEA Trust Commercial |
$1,206.92
|
| Rate for Payer: WPS Commercial |
$1,625.33
|
|
|
SET SMALL BORE EXTENTION 60 IN #MX448L60
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2974610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
SET SMALL BORE EXTENTION 60 IN #MX448L60
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2974610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
SET ULTRATHANE MCLEAN ENTERAL FEEDING TUBE 9.5 FR. #MRT-9.5-130
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2972284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
SET ULTRATHANE MCLEAN ENTERAL FEEDING TUBE 9.5 FR. #MRT-9.5-130
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2972284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Setup - Therapeutic Gases Charge
|
Facility
|
OP
|
$725.00
|
|
| Hospital Charge Code |
3004206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$211.12 |
| Max. Negotiated Rate |
$693.68 |
| Rate for Payer: Aetna Commercial |
$678.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Aetna Managed Medicare |
$211.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.62
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$693.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.95
|
| Rate for Payer: Health EOS Commercial |
$671.06
|
| Rate for Payer: HFN Commercial |
$693.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: NAPHCARE Commercial |
$452.40
|
| Rate for Payer: Preferred Network Access Commercial |
$693.68
|
| Rate for Payer: Quartz Beloit One Network |
$369.46
|
| Rate for Payer: Quartz Commercial |
$490.10
|
| Rate for Payer: Quartz Medicare Advantage |
$452.40
|
| Rate for Payer: The Alliance Commercial |
$377.00
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: WPS Commercial |
$558.47
|
|
|
Setup - Therapeutic Gases Charge
|
Facility
|
IP
|
$725.00
|
|
| Hospital Charge Code |
3004206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$369.46 |
| Max. Negotiated Rate |
$693.68 |
| Rate for Payer: Aetna Commercial |
$678.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.62
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$693.68
|
| Rate for Payer: Health EOS Commercial |
$671.06
|
| Rate for Payer: HFN Commercial |
$693.68
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Preferred Network Access Commercial |
$693.68
|
| Rate for Payer: Quartz Beloit One Network |
$369.46
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: WPS Commercial |
$558.47
|
|
|
SET Y-TYPE TUR BLADDER IRRIGATION 2C4041
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
2963418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SET Y-TYPE TUR BLADDER IRRIGATION 2C4041
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
2963418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2943014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$22.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.51
|
| Rate for Payer: Anthem Medicare Advantage |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.60
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.60
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$33.90
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| Rate for Payer: Quartz Medicare Advantage |
$22.60
|
| Rate for Payer: The Alliance Commercial |
$90.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.60
|
| Rate for Payer: United Healthcare PPO |
$155.22
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: Wellcare Medicare |
$22.60
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
Sex Hormone Binding Globulin
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2943014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$196.61 |
| Rate for Payer: Aetna Commercial |
$196.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$22.60
|
| Rate for Payer: Anthem Medicare Advantage |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.60
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$196.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.60
|
| Rate for Payer: Health EOS Commercial |
$188.33
|
| Rate for Payer: HFN Commercial |
$196.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$33.90
|
| Rate for Payer: Preferred Network Access Commercial |
$196.61
|
| Rate for Payer: Quartz Beloit One Network |
$91.06
|
| Rate for Payer: Quartz Commercial |
$117.97
|
| Rate for Payer: Quartz Medicare Advantage |
$22.60
|
| Rate for Payer: The Alliance Commercial |
$89.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.60
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$99.44
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
978066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$283.21 |
| Rate for Payer: Aetna Commercial |
$277.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Managed Medicare |
$22.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.51
|
| Rate for Payer: Anthem Medicare Advantage |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.60
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$283.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.60
|
| Rate for Payer: Health EOS Commercial |
$273.98
|
| Rate for Payer: HFN Commercial |
$283.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: NAPHCARE Commercial |
$33.90
|
| Rate for Payer: Preferred Network Access Commercial |
$283.21
|
| Rate for Payer: Quartz Beloit One Network |
$150.84
|
| Rate for Payer: Quartz Commercial |
$200.10
|
| Rate for Payer: Quartz Medicare Advantage |
$22.60
|
| Rate for Payer: The Alliance Commercial |
$90.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.60
|
| Rate for Payer: United Healthcare PPO |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: Wellcare Medicare |
$22.60
|
| Rate for Payer: WPS Commercial |
$228.01
|
|
|
Sex Hormone Binding Globulin
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
978066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$292.45 |
| Rate for Payer: Aetna Commercial |
$292.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Managed Medicare |
$22.60
|
| Rate for Payer: Anthem Medicare Advantage |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.60
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$292.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.60
|
| Rate for Payer: Health EOS Commercial |
$280.13
|
| Rate for Payer: HFN Commercial |
$292.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: NAPHCARE Commercial |
$33.90
|
| Rate for Payer: Preferred Network Access Commercial |
$292.45
|
| Rate for Payer: Quartz Beloit One Network |
$135.45
|
| Rate for Payer: Quartz Commercial |
$175.47
|
| Rate for Payer: Quartz Medicare Advantage |
$22.60
|
| Rate for Payer: The Alliance Commercial |
$89.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.60
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: WPS Commercial |
$99.44
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
978066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$283.21 |
| Rate for Payer: Aetna Commercial |
$277.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.16
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$283.21
|
| Rate for Payer: Health EOS Commercial |
$273.98
|
| Rate for Payer: HFN Commercial |
$283.21
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: Preferred Network Access Commercial |
$283.21
|
| Rate for Payer: Quartz Beloit One Network |
$150.84
|
| Rate for Payer: Quartz Commercial |
$184.70
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: WPS Commercial |
$228.01
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2943014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$124.18
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
Sezary Diagnostic Flow Cytometry
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Sezary Diagnostic Flow Cytometry
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
