|
STYLET FALLER TUNNELLING 8888415679
|
Facility
|
IP
|
$2,637.00
|
|
| Hospital Charge Code |
4520283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,292.13 |
| Max. Negotiated Rate |
$2,426.04 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,582.20
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
STYLET FALLER TUNNELLING 8888415679
|
Facility
|
OP
|
$2,637.00
|
|
| Hospital Charge Code |
4520283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$738.36 |
| Max. Negotiated Rate |
$10,548.00 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Aetna Managed Medicare |
$738.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.67
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,977.75
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,714.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.20
|
| Rate for Payer: The Alliance Commercial |
$10,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
STYLET INTUBATING SZ 5.0-10MM #85865
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2974644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
STYLET INTUBATING SZ 5.0-10MM #85865
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2974644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
STYLET SATIN SLIP-ADULT 10FR 5-15101
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
STYLET SATIN SLIP-ADULT 10FR 5-15101
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
STYLET SATIN SLIP -PEDS 6FR DYND43506***DEDE 10/23
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2963540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
STYLET SATIN SLIP -PEDS 6FR DYND43506***DEDE 10/23
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2963540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
STYLET SPRING WIRE GUIDE
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
2962948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.32 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna Commercial |
$332.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Aetna Managed Medicare |
$103.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.57
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$339.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.49
|
| Rate for Payer: Health EOS Commercial |
$328.41
|
| Rate for Payer: HFN Commercial |
$339.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.75
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: NAPHCARE Commercial |
$221.40
|
| Rate for Payer: Preferred Network Access Commercial |
$339.48
|
| Rate for Payer: Quartz Beloit One Network |
$180.81
|
| Rate for Payer: Quartz Commercial |
$239.85
|
| Rate for Payer: Quartz Medicare Advantage |
$221.40
|
| Rate for Payer: The Alliance Commercial |
$1,476.00
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
STYLET SPRING WIRE GUIDE
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
2962948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$339.48 |
| Rate for Payer: Aetna Commercial |
$332.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.57
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$339.48
|
| Rate for Payer: Health EOS Commercial |
$328.41
|
| Rate for Payer: HFN Commercial |
$339.48
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: NAPHCARE Commercial |
$221.40
|
| Rate for Payer: Preferred Network Access Commercial |
$339.48
|
| Rate for Payer: Quartz Beloit One Network |
$180.81
|
| Rate for Payer: Quartz Commercial |
$221.40
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
SUBACROMIAL DECOMPRESSION
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.93 |
| Max. Negotiated Rate |
$4,284.44 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$2,794.20
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
SUBACROMIAL DECOMPRESSION
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,303.96 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,303.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,027.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,328.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,606.06
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,492.75
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$3,027.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,794.20
|
| Rate for Payer: The Alliance Commercial |
$18,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
Subconjunctival Injection
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
1188934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$299.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$299.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.00
|
| Rate for Payer: Health EOS Commercial |
$286.65
|
| Rate for Payer: HFN Commercial |
$299.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.18
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$299.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.60
|
| Rate for Payer: Quartz Commercial |
$179.55
|
| Rate for Payer: The Alliance Commercial |
$157.50
|
| Rate for Payer: United Healthcare Medicaid |
$29.52
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
Subconjunctival Injenction 6820050
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
CPT 68200 50
|
| Hospital Charge Code |
5438754
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$563.35 |
| Rate for Payer: Aetna Commercial |
$563.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.98
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$563.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.80
|
| Rate for Payer: Health EOS Commercial |
$539.63
|
| Rate for Payer: HFN Commercial |
$563.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.18
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: Preferred Network Access Commercial |
$563.35
|
| Rate for Payer: Quartz Beloit One Network |
$260.92
|
| Rate for Payer: Quartz Commercial |
$338.01
|
| Rate for Payer: The Alliance Commercial |
$296.50
|
| Rate for Payer: United Healthcare Medicaid |
$29.52
|
| Rate for Payer: WEA Trust Commercial |
$326.15
|
| Rate for Payer: WPS Commercial |
$439.24
|
|
|
SUBFASCIAL ENDOSCOPIC PERFORATER SURGERY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960369
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.64 |
| Max. Negotiated Rate |
$26,852.00 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,363.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,356.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,756.59
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.75
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,363.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,027.80
|
| Rate for Payer: The Alliance Commercial |
$26,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
SUBFASCIAL ENDOSCOPIC PERFORATER SURGERY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960369
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,289.37 |
| Max. Negotiated Rate |
$6,175.96 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,027.80
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
SUBMUCOSAL INJECTION
|
Facility
|
IP
|
$917.00
|
|
| Hospital Charge Code |
4253750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$449.33 |
| Max. Negotiated Rate |
$843.64 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$550.20
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
SUBMUCOSAL INJECTION
|
Facility
|
OP
|
$917.00
|
|
| Hospital Charge Code |
4253750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$3,668.00 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$256.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.15
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$596.05
|
| Rate for Payer: Quartz Medicare Advantage |
$550.20
|
| Rate for Payer: The Alliance Commercial |
$3,668.00
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
Subsequent - Chest Physiotherapy Charge
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
2990158
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.92
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$83.85
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$96.75
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Subsequent - Chest Physiotherapy Charge
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
2990158
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$77.40
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Subsequent - Handheld Nebulizer Charge
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990156
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$843.28 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.88
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: The Alliance Commercial |
$843.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Subsequent - Handheld Nebulizer Charge
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990156
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Subsequent Hospital Care 99231
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
4001096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Aetna Managed Medicare |
$71.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.70
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$165.75
|
| Rate for Payer: Quartz Medicare Advantage |
$153.00
|
| Rate for Payer: The Alliance Commercial |
$1,020.00
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
Subsequent Hospital Care 99231
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
4001096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
