|
Single Biopatch used - PA Line Dressing/Activity
|
Facility
|
OP
|
$196.00
|
|
| Hospital Charge Code |
3025925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$57.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$101.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.07
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$132.50
|
| Rate for Payer: Quartz Medicare Advantage |
$122.30
|
| Rate for Payer: The Alliance Commercial |
$101.92
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
Single Biopatch used - PA Line Dressing/Activity
|
Facility
|
IP
|
$196.00
|
|
| Hospital Charge Code |
3025925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$122.30
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
SINGLE DUAL OR MULTIPLE LEAD IMPLANTABLE 9328726
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 93287 26
|
| Hospital Charge Code |
3015362
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$384.33 |
| Rate for Payer: Aetna Commercial |
$384.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Aetna Managed Medicare |
$21.82
|
| Rate for Payer: Anthem Medicare Advantage |
$21.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.82
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$384.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.82
|
| Rate for Payer: Health EOS Commercial |
$368.15
|
| Rate for Payer: HFN Commercial |
$384.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.82
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$32.73
|
| Rate for Payer: Preferred Network Access Commercial |
$384.33
|
| Rate for Payer: Quartz Beloit One Network |
$178.01
|
| Rate for Payer: Quartz Commercial |
$230.60
|
| Rate for Payer: Quartz Medicare Advantage |
$21.82
|
| Rate for Payer: The Alliance Commercial |
$82.91
|
| Rate for Payer: United Healthcare Medicaid |
$22.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.82
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$87.28
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$52,171.44
|
|
|
Service Code
|
APR-DRG 3004
|
| Min. Negotiated Rate |
$46,341.93 |
| Max. Negotiated Rate |
$52,171.44 |
| Rate for Payer: Anthem Medicaid |
$49,957.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$49,957.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49,957.03
|
| Rate for Payer: Dean Health Medicaid |
$49,957.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46,341.93
|
| Rate for Payer: Managed Health Services Medicaid |
$52,171.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$49,957.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$49,957.03
|
| Rate for Payer: United Healthcare Medicaid |
$49,957.03
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$27,970.91
|
|
|
Service Code
|
APR-DRG 3002
|
| Min. Negotiated Rate |
$24,845.51 |
| Max. Negotiated Rate |
$27,970.91 |
| Rate for Payer: Anthem Medicaid |
$26,783.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,783.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,783.69
|
| Rate for Payer: Dean Health Medicaid |
$26,783.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,845.51
|
| Rate for Payer: Managed Health Services Medicaid |
$27,970.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,783.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,783.69
|
| Rate for Payer: United Healthcare Medicaid |
$26,783.69
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$24,638.95
|
|
|
Service Code
|
APR-DRG 3001
|
| Min. Negotiated Rate |
$21,885.85 |
| Max. Negotiated Rate |
$24,638.95 |
| Rate for Payer: Anthem Medicaid |
$23,593.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,593.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,593.15
|
| Rate for Payer: Dean Health Medicaid |
$23,593.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,885.85
|
| Rate for Payer: Managed Health Services Medicaid |
$24,638.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,593.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,593.15
|
| Rate for Payer: United Healthcare Medicaid |
$23,593.15
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$36,476.17
|
|
|
Service Code
|
APR-DRG 3003
|
| Min. Negotiated Rate |
$32,400.41 |
| Max. Negotiated Rate |
$36,476.17 |
| Rate for Payer: Anthem Medicaid |
$34,927.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$34,927.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34,927.94
|
| Rate for Payer: Dean Health Medicaid |
$34,927.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32,400.41
|
| Rate for Payer: Managed Health Services Medicaid |
$36,476.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,927.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34,927.94
|
| Rate for Payer: United Healthcare Medicaid |
$34,927.94
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$87,724.09
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$31,296.55 |
| Max. Negotiated Rate |
$87,724.09 |
| Rate for Payer: Aetna Managed Medicare |
$31,296.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87,724.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67,239.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63,882.21
|
| Rate for Payer: Anthem Medicare Advantage |
$31,296.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,296.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,296.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,296.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70,915.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,296.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,296.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,296.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,296.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,296.55
|
| Rate for Payer: NAPHCARE Commercial |
$46,944.83
|
| Rate for Payer: Quartz Medicare Advantage |
$31,296.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,296.55
|
| Rate for Payer: Wellcare Medicare |
$31,296.55
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$116,287.61
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$41,321.90 |
| Max. Negotiated Rate |
$116,287.61 |
| Rate for Payer: Aetna Managed Medicare |
$41,321.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116,287.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89,133.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84,682.65
|
| Rate for Payer: Anthem Medicare Advantage |
$41,321.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41,321.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41,321.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41,321.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94,005.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41,321.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41,321.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41,321.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41,321.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41,321.90
|
| Rate for Payer: NAPHCARE Commercial |
$61,982.86
|
| Rate for Payer: Quartz Medicare Advantage |
$41,321.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,321.90
|
| Rate for Payer: Wellcare Medicare |
$41,321.90
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$70,484.74
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$25,245.81 |
| Max. Negotiated Rate |
$70,484.74 |
| Rate for Payer: Aetna Managed Medicare |
$25,245.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,484.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,025.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,328.21
|
| Rate for Payer: Anthem Medicare Advantage |
$25,245.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,245.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,245.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,245.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,979.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,245.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,245.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,245.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,245.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,245.81
|
| Rate for Payer: NAPHCARE Commercial |
$37,868.72
|
| Rate for Payer: Quartz Medicare Advantage |
$25,245.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,245.81
|
| Rate for Payer: Wellcare Medicare |
$25,245.81
|
|
|
SINU-KNIT NASAL DRESSING RR600
|
Facility
|
OP
|
$1,016.00
|
|
| Hospital Charge Code |
3092805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Aetna Managed Medicare |
$295.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$686.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$528.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$507.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.31
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.48
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: NAPHCARE Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$686.82
|
| Rate for Payer: Quartz Medicare Advantage |
$633.98
|
| Rate for Payer: The Alliance Commercial |
$528.32
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
SINU-KNIT NASAL DRESSING RR600
|
Facility
|
IP
|
$1,016.00
|
|
| Hospital Charge Code |
3092805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$517.75 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$633.98
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$73,662.16
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$17,125.07 |
| Max. Negotiated Rate |
$73,662.16 |
| Rate for Payer: Aetna Managed Medicare |
$17,125.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,151.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,375.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,608.67
|
| Rate for Payer: Anthem Medicare Advantage |
$17,125.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,125.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,125.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,125.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,308.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,125.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53,784.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,125.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,125.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,125.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,125.07
|
| Rate for Payer: NAPHCARE Commercial |
$25,687.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17,125.07
|
| Rate for Payer: The Alliance Commercial |
$73,662.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,125.07
|
| Rate for Payer: United Healthcare PPO |
$41,871.99
|
| Rate for Payer: Wellcare Medicare |
$17,125.07
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,207.36
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$8,282.15 |
| Max. Negotiated Rate |
$29,207.36 |
| Rate for Payer: Aetna Managed Medicare |
$8,282.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,153.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,980.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,132.22
|
| Rate for Payer: Anthem Medicare Advantage |
$8,282.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,282.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,282.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,282.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,908.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,282.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,044.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,282.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,282.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,282.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,282.15
|
| Rate for Payer: NAPHCARE Commercial |
$12,423.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8,282.15
|
| Rate for Payer: The Alliance Commercial |
$29,207.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,282.15
|
| Rate for Payer: United Healthcare PPO |
$14,826.74
|
| Rate for Payer: Wellcare Medicare |
$8,282.15
|
|
|
SINUS BALLOON DILATION TOOL MULTI-SINUS XPRESS ENTELLUS 6 X 20 LPLF-106
|
Facility
|
IP
|
$10,910.00
|
|
| Hospital Charge Code |
3157461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,559.74 |
| Max. Negotiated Rate |
$10,438.69 |
| Rate for Payer: Aetna Commercial |
$10,211.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,757.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,013.59
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cigna Commercial |
$10,438.69
|
| Rate for Payer: Health EOS Commercial |
$10,098.30
|
| Rate for Payer: HFN Commercial |
$10,438.69
|
| Rate for Payer: Multiplan Commercial |
$9,077.12
|
| Rate for Payer: Preferred Network Access Commercial |
$10,438.69
|
| Rate for Payer: Quartz Beloit One Network |
$5,559.74
|
| Rate for Payer: Quartz Commercial |
$6,807.84
|
| Rate for Payer: WEA Trust Commercial |
$6,240.52
|
| Rate for Payer: WPS Commercial |
$8,403.97
|
|
|
SINUS BALLOON DILATION TOOL MULTI-SINUS XPRESS ENTELLUS 6 X 20 LPLF-106
|
Facility
|
OP
|
$10,910.00
|
|
| Hospital Charge Code |
3157461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,176.99 |
| Max. Negotiated Rate |
$10,438.69 |
| Rate for Payer: Aetna Commercial |
$10,211.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,757.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,176.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,375.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,673.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,446.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,013.59
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cigna Commercial |
$10,438.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,349.62
|
| Rate for Payer: Health EOS Commercial |
$10,098.30
|
| Rate for Payer: HFN Commercial |
$10,438.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,509.80
|
| Rate for Payer: Multiplan Commercial |
$9,077.12
|
| Rate for Payer: NAPHCARE Commercial |
$6,807.84
|
| Rate for Payer: Preferred Network Access Commercial |
$10,438.69
|
| Rate for Payer: Quartz Beloit One Network |
$5,559.74
|
| Rate for Payer: Quartz Commercial |
$7,375.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6,807.84
|
| Rate for Payer: The Alliance Commercial |
$5,673.20
|
| Rate for Payer: WEA Trust Commercial |
$6,240.52
|
| Rate for Payer: WPS Commercial |
$8,403.97
|
|
|
SINUS BALLOON DILATION TOOL MULTI-SINUS XPRESS ENTELLUS 6 X 8 LPLF-206
|
Facility
|
IP
|
$10,910.00
|
|
| Hospital Charge Code |
3157483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,559.74 |
| Max. Negotiated Rate |
$10,438.69 |
| Rate for Payer: Aetna Commercial |
$10,211.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,757.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,013.59
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cigna Commercial |
$10,438.69
|
| Rate for Payer: Health EOS Commercial |
$10,098.30
|
| Rate for Payer: HFN Commercial |
$10,438.69
|
| Rate for Payer: Multiplan Commercial |
$9,077.12
|
| Rate for Payer: Preferred Network Access Commercial |
$10,438.69
|
| Rate for Payer: Quartz Beloit One Network |
$5,559.74
|
| Rate for Payer: Quartz Commercial |
$6,807.84
|
| Rate for Payer: WEA Trust Commercial |
$6,240.52
|
| Rate for Payer: WPS Commercial |
$8,403.97
|
|
|
SINUS BALLOON DILATION TOOL MULTI-SINUS XPRESS ENTELLUS 6 X 8 LPLF-206
|
Facility
|
OP
|
$10,910.00
|
|
| Hospital Charge Code |
3157483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,176.99 |
| Max. Negotiated Rate |
$10,438.69 |
| Rate for Payer: Aetna Commercial |
$10,211.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,757.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,176.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,375.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,673.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,446.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,013.59
|
| Rate for Payer: Cash Price |
$3,273.00
|
| Rate for Payer: Cigna Commercial |
$10,438.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,349.62
|
| Rate for Payer: Health EOS Commercial |
$10,098.30
|
| Rate for Payer: HFN Commercial |
$10,438.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,509.80
|
| Rate for Payer: Multiplan Commercial |
$9,077.12
|
| Rate for Payer: NAPHCARE Commercial |
$6,807.84
|
| Rate for Payer: Preferred Network Access Commercial |
$10,438.69
|
| Rate for Payer: Quartz Beloit One Network |
$5,559.74
|
| Rate for Payer: Quartz Commercial |
$7,375.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6,807.84
|
| Rate for Payer: The Alliance Commercial |
$5,673.20
|
| Rate for Payer: WEA Trust Commercial |
$6,240.52
|
| Rate for Payer: WPS Commercial |
$8,403.97
|
|
|
SINUS BALLOON DILATION TOOL MULTI-SINUS XPRESS ULTRA ENTELLUS 6 X 20 ULF-106
|
Facility
|
OP
|
$10,926.00
|
|
| Hospital Charge Code |
5432721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,181.65 |
| Max. Negotiated Rate |
$10,454.00 |
| Rate for Payer: Aetna Commercial |
$10,226.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,772.21
|
| Rate for Payer: Aetna Managed Medicare |
$3,181.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,385.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,681.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,454.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,022.41
|
| Rate for Payer: Cash Price |
$3,277.80
|
| Rate for Payer: Cigna Commercial |
$10,454.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,358.93
|
| Rate for Payer: Health EOS Commercial |
$10,113.11
|
| Rate for Payer: HFN Commercial |
$10,454.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,522.28
|
| Rate for Payer: Multiplan Commercial |
$9,090.43
|
| Rate for Payer: NAPHCARE Commercial |
$6,817.82
|
| Rate for Payer: Preferred Network Access Commercial |
$10,454.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,567.89
|
| Rate for Payer: Quartz Commercial |
$7,385.98
|
| Rate for Payer: Quartz Medicare Advantage |
$6,817.82
|
| Rate for Payer: The Alliance Commercial |
$5,681.52
|
| Rate for Payer: WEA Trust Commercial |
$6,249.67
|
| Rate for Payer: WPS Commercial |
$8,416.30
|
|
|
SINUS BALLOON DILATION TOOL MULTI-SINUS XPRESS ULTRA ENTELLUS 6 X 20 ULF-106
|
Facility
|
IP
|
$10,926.00
|
|
| Hospital Charge Code |
5432721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,567.89 |
| Max. Negotiated Rate |
$10,454.00 |
| Rate for Payer: Aetna Commercial |
$10,226.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,772.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,022.41
|
| Rate for Payer: Cash Price |
$3,277.80
|
| Rate for Payer: Cigna Commercial |
$10,454.00
|
| Rate for Payer: Health EOS Commercial |
$10,113.11
|
| Rate for Payer: HFN Commercial |
$10,454.00
|
| Rate for Payer: Multiplan Commercial |
$9,090.43
|
| Rate for Payer: Preferred Network Access Commercial |
$10,454.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,567.89
|
| Rate for Payer: Quartz Commercial |
$6,817.82
|
| Rate for Payer: WEA Trust Commercial |
$6,249.67
|
| Rate for Payer: WPS Commercial |
$8,416.30
|
|
|
SINUS BALLOON INFLATOR KIT MEDTRONIC 18INFKIT
|
Facility
|
OP
|
$2,695.00
|
|
| Hospital Charge Code |
4230456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.78 |
| Max. Negotiated Rate |
$2,578.58 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,410.41
|
| Rate for Payer: Aetna Managed Medicare |
$784.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,821.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,401.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,345.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,485.48
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cigna Commercial |
$2,578.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,568.49
|
| Rate for Payer: Health EOS Commercial |
$2,494.49
|
| Rate for Payer: HFN Commercial |
$2,578.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,102.10
|
| Rate for Payer: Multiplan Commercial |
$2,242.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,681.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.37
|
| Rate for Payer: Quartz Commercial |
$1,821.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,681.68
|
| Rate for Payer: The Alliance Commercial |
$1,401.40
|
| Rate for Payer: WEA Trust Commercial |
$1,541.54
|
| Rate for Payer: WPS Commercial |
$2,075.96
|
|
|
SINUS BALLOON INFLATOR KIT MEDTRONIC 18INFKIT
|
Facility
|
IP
|
$2,695.00
|
|
| Hospital Charge Code |
4230456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,373.37 |
| Max. Negotiated Rate |
$2,578.58 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,410.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,485.48
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cigna Commercial |
$2,578.58
|
| Rate for Payer: Health EOS Commercial |
$2,494.49
|
| Rate for Payer: HFN Commercial |
$2,578.58
|
| Rate for Payer: Multiplan Commercial |
$2,242.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.37
|
| Rate for Payer: Quartz Commercial |
$1,681.68
|
| Rate for Payer: WEA Trust Commercial |
$1,541.54
|
| Rate for Payer: WPS Commercial |
$2,075.96
|
|
|
SINUS BALLOON SEEKER EM FRONTAL 6 X 17MM MEDTRONIC 1830617FRT
|
Facility
|
OP
|
$7,872.00
|
|
| Hospital Charge Code |
4230453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,292.33 |
| Max. Negotiated Rate |
$7,531.93 |
| Rate for Payer: Aetna Commercial |
$7,368.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,040.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,292.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,321.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,093.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,929.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,339.05
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cigna Commercial |
$7,531.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,581.50
|
| Rate for Payer: Health EOS Commercial |
$7,286.32
|
| Rate for Payer: HFN Commercial |
$7,531.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,140.16
|
| Rate for Payer: Multiplan Commercial |
$6,549.50
|
| Rate for Payer: NAPHCARE Commercial |
$4,912.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,531.93
|
| Rate for Payer: Quartz Beloit One Network |
$4,011.57
|
| Rate for Payer: Quartz Commercial |
$5,321.47
|
| Rate for Payer: Quartz Medicare Advantage |
$4,912.13
|
| Rate for Payer: The Alliance Commercial |
$4,093.44
|
| Rate for Payer: WEA Trust Commercial |
$4,502.78
|
| Rate for Payer: WPS Commercial |
$6,063.80
|
|
|
SINUS BALLOON SEEKER EM FRONTAL 6 X 17MM MEDTRONIC 1830617FRT
|
Facility
|
IP
|
$7,872.00
|
|
| Hospital Charge Code |
4230453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,011.57 |
| Max. Negotiated Rate |
$7,531.93 |
| Rate for Payer: Aetna Commercial |
$7,368.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,040.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,339.05
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cigna Commercial |
$7,531.93
|
| Rate for Payer: Health EOS Commercial |
$7,286.32
|
| Rate for Payer: HFN Commercial |
$7,531.93
|
| Rate for Payer: Multiplan Commercial |
$6,549.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,531.93
|
| Rate for Payer: Quartz Beloit One Network |
$4,011.57
|
| Rate for Payer: Quartz Commercial |
$4,912.13
|
| Rate for Payer: WEA Trust Commercial |
$4,502.78
|
| Rate for Payer: WPS Commercial |
$6,063.80
|
|
|
SINUS BALLOON SEEKER EM MAXILLARY 6 X 7MM MEDTRONIC 1830607MAX
|
Facility
|
OP
|
$3,693.00
|
|
| Hospital Charge Code |
4230452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.40 |
| Max. Negotiated Rate |
$3,533.46 |
| Rate for Payer: Aetna Commercial |
$3,456.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,303.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,075.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,496.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,920.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,843.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,035.58
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna Commercial |
$3,533.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,149.33
|
| Rate for Payer: Health EOS Commercial |
$3,418.24
|
| Rate for Payer: HFN Commercial |
$3,533.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,880.54
|
| Rate for Payer: Multiplan Commercial |
$3,072.58
|
| Rate for Payer: NAPHCARE Commercial |
$2,304.43
|
| Rate for Payer: Preferred Network Access Commercial |
$3,533.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,881.95
|
| Rate for Payer: Quartz Commercial |
$2,496.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,304.43
|
| Rate for Payer: The Alliance Commercial |
$1,920.36
|
| Rate for Payer: WEA Trust Commercial |
$2,112.40
|
| Rate for Payer: WPS Commercial |
$2,844.72
|
|
