|
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING, BILAT 32554-50
|
Professional
|
Both
|
$3,158.00
|
|
|
Service Code
|
CPT 32554 50
|
| Hospital Charge Code |
6174317
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$3,000.10 |
| Rate for Payer: Aetna Commercial |
$3,000.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,715.88
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cigna Commercial |
$3,000.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,894.80
|
| Rate for Payer: Health EOS Commercial |
$2,873.78
|
| Rate for Payer: HFN Commercial |
$3,000.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$2,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,000.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,389.52
|
| Rate for Payer: Quartz Commercial |
$1,800.06
|
| Rate for Payer: The Alliance Commercial |
$1,579.00
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: WEA Trust Commercial |
$1,736.90
|
| Rate for Payer: WPS Commercial |
$2,339.13
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$620.92 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
|
|
Thoracentesis Performed By
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2844884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$1,045.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.32
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.76
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,069.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$1,034.18
|
| Rate for Payer: HFN Commercial |
$1,069.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.04
|
| Rate for Payer: Quartz Beloit One Network |
$569.38
|
| Rate for Payer: Quartz Commercial |
$755.30
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$860.69
|
|
|
Thoracentesis Performed By
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2844884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$569.38 |
| Max. Negotiated Rate |
$1,069.04 |
| Rate for Payer: Aetna Commercial |
$1,045.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.86
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,069.04
|
| Rate for Payer: Health EOS Commercial |
$1,034.18
|
| Rate for Payer: HFN Commercial |
$1,069.04
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: NAPHCARE Commercial |
$697.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.04
|
| Rate for Payer: Quartz Beloit One Network |
$569.38
|
| Rate for Payer: Quartz Commercial |
$697.20
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: WPS Commercial |
$860.69
|
|
|
Thoracentesis w/Imag 32555
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
3157536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Aetna Commercial |
$1,767.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,599.60
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cigna Commercial |
$1,767.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,116.00
|
| Rate for Payer: Health EOS Commercial |
$1,692.60
|
| Rate for Payer: HFN Commercial |
$1,767.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$373.90
|
| Rate for Payer: Multiplan Commercial |
$1,488.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,767.00
|
| Rate for Payer: Quartz Beloit One Network |
$818.40
|
| Rate for Payer: Quartz Commercial |
$1,060.20
|
| Rate for Payer: The Alliance Commercial |
$930.00
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: WEA Trust Commercial |
$1,023.00
|
| Rate for Payer: WPS Commercial |
$1,377.70
|
|
|
Thoracentesis w/Imaging
|
Facility
|
OP
|
$2,361.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
5605764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$2,124.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.46
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,534.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,180.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,133.28
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cigna Commercial |
$2,172.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$2,101.29
|
| Rate for Payer: HFN Commercial |
$2,172.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$1,888.80
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,172.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.89
|
| Rate for Payer: Quartz Commercial |
$1,534.65
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,298.55
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$1,748.79
|
|
|
Thoracentesis w/Imaging
|
Facility
|
IP
|
$2,361.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
5605764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,156.89 |
| Max. Negotiated Rate |
$2,172.12 |
| Rate for Payer: Aetna Commercial |
$2,124.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.33
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cigna Commercial |
$2,172.12
|
| Rate for Payer: Health EOS Commercial |
$2,101.29
|
| Rate for Payer: HFN Commercial |
$2,172.12
|
| Rate for Payer: Multiplan Commercial |
$1,888.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,416.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,172.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.89
|
| Rate for Payer: Quartz Commercial |
$1,416.60
|
| Rate for Payer: WEA Trust Commercial |
$1,298.55
|
| Rate for Payer: WPS Commercial |
$1,748.79
|
|
|
Thoracentesis w/o Img 32554
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
3127501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$1,500.05 |
| Rate for Payer: Aetna Commercial |
$1,500.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.94
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,500.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$947.40
|
| Rate for Payer: Health EOS Commercial |
$1,436.89
|
| Rate for Payer: HFN Commercial |
$1,500.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,500.05
|
| Rate for Payer: Quartz Beloit One Network |
$694.76
|
| Rate for Payer: Quartz Commercial |
$900.03
|
| Rate for Payer: The Alliance Commercial |
$789.50
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: WEA Trust Commercial |
$868.45
|
| Rate for Payer: WPS Commercial |
$1,169.57
|
|
|
Thoracic Gas Volume - Pulmonary Function Test Charge
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3006991
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$462.56 |
| Max. Negotiated Rate |
$868.48 |
| Rate for Payer: Aetna Commercial |
$849.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$811.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.32
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$868.48
|
| Rate for Payer: Health EOS Commercial |
$840.16
|
| Rate for Payer: HFN Commercial |
$868.48
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: NAPHCARE Commercial |
$566.40
|
| Rate for Payer: Preferred Network Access Commercial |
$868.48
|
| Rate for Payer: Quartz Beloit One Network |
$462.56
|
| Rate for Payer: Quartz Commercial |
$566.40
|
| Rate for Payer: WEA Trust Commercial |
$519.20
|
| Rate for Payer: WPS Commercial |
$699.22
|
|
|
Thoracic Gas Volume - Pulmonary Function Test Charge
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3006991
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,240.96 |
| Rate for Payer: Aetna Commercial |
$849.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$811.84
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$613.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.12
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$868.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$840.16
|
| Rate for Payer: HFN Commercial |
$868.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$755.20
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$868.48
|
| Rate for Payer: Quartz Beloit One Network |
$462.56
|
| Rate for Payer: Quartz Commercial |
$613.60
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$708.00
|
| Rate for Payer: WEA Trust Commercial |
$519.20
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$699.22
|
|
|
THORACIC SURGERY, VIDEO ASSISTED (VATS)
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2950344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
THORACIC SURGERY, VIDEO ASSISTED (VATS)
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2950344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
THORACOLUMBAR SYMPATHECTOMY
|
Facility
|
OP
|
$7,778.00
|
|
| Hospital Charge Code |
2960399
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,177.84 |
| Max. Negotiated Rate |
$31,112.00 |
| Rate for Payer: Aetna Commercial |
$7,000.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,689.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,177.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,055.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,889.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,733.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,122.34
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,155.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,352.57
|
| Rate for Payer: Health EOS Commercial |
$6,922.42
|
| Rate for Payer: HFN Commercial |
$7,155.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,833.50
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,811.22
|
| Rate for Payer: Quartz Commercial |
$5,055.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,666.80
|
| Rate for Payer: The Alliance Commercial |
$31,112.00
|
| Rate for Payer: WEA Trust Commercial |
$4,277.90
|
| Rate for Payer: WPS Commercial |
$5,761.16
|
|
|
THORACOLUMBAR SYMPATHECTOMY
|
Facility
|
IP
|
$7,778.00
|
|
| Hospital Charge Code |
2960399
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,811.22 |
| Max. Negotiated Rate |
$7,155.76 |
| Rate for Payer: Aetna Commercial |
$7,000.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,122.34
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,155.76
|
| Rate for Payer: Health EOS Commercial |
$6,922.42
|
| Rate for Payer: HFN Commercial |
$7,155.76
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,811.22
|
| Rate for Payer: Quartz Commercial |
$4,666.80
|
| Rate for Payer: WEA Trust Commercial |
$4,277.90
|
| Rate for Payer: WPS Commercial |
$5,761.16
|
|
|
THORACOTOMY/BLEB RESECTION/DECORTICATION/LUNG WEDGE RESECTION /PLICATION
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
THORACOTOMY/BLEB RESECTION/DECORTICATION/LUNG WEDGE RESECTION /PLICATION
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
THREADED ROD 6MM X 100MM (USE W M6 NUT) 4933-1-100
|
Facility
|
OP
|
$863.00
|
|
| Hospital Charge Code |
6190960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.64 |
| Max. Negotiated Rate |
$3,452.00 |
| Rate for Payer: Aetna Commercial |
$776.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$742.18
|
| Rate for Payer: Aetna Managed Medicare |
$241.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$560.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$431.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$414.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.39
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$793.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$482.93
|
| Rate for Payer: Health EOS Commercial |
$768.07
|
| Rate for Payer: HFN Commercial |
$793.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$647.25
|
| Rate for Payer: Multiplan Commercial |
$690.40
|
| Rate for Payer: NAPHCARE Commercial |
$517.80
|
| Rate for Payer: Preferred Network Access Commercial |
$793.96
|
| Rate for Payer: Quartz Beloit One Network |
$422.87
|
| Rate for Payer: Quartz Commercial |
$560.95
|
| Rate for Payer: Quartz Medicare Advantage |
$517.80
|
| Rate for Payer: The Alliance Commercial |
$3,452.00
|
| Rate for Payer: WEA Trust Commercial |
$474.65
|
| Rate for Payer: WPS Commercial |
$639.22
|
|
|
THREADED ROD 6MM X 100MM (USE W M6 NUT) 4933-1-100
|
Facility
|
IP
|
$863.00
|
|
| Hospital Charge Code |
6190960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.87 |
| Max. Negotiated Rate |
$793.96 |
| Rate for Payer: Aetna Commercial |
$776.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$742.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.39
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$793.96
|
| Rate for Payer: Health EOS Commercial |
$768.07
|
| Rate for Payer: HFN Commercial |
$793.96
|
| Rate for Payer: Multiplan Commercial |
$690.40
|
| Rate for Payer: NAPHCARE Commercial |
$517.80
|
| Rate for Payer: Preferred Network Access Commercial |
$793.96
|
| Rate for Payer: Quartz Beloit One Network |
$422.87
|
| Rate for Payer: Quartz Commercial |
$517.80
|
| Rate for Payer: WEA Trust Commercial |
$474.65
|
| Rate for Payer: WPS Commercial |
$639.22
|
|
|
THREADED ROD 6MM X 120MM (USE W M6 NUT) 4933-1-120
|
Facility
|
OP
|
$898.00
|
|
| Hospital Charge Code |
6001639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$449.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$431.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.52
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
THREADED ROD 6MM X 120MM (USE W M6 NUT) 4933-1-120
|
Facility
|
IP
|
$898.00
|
|
| Hospital Charge Code |
6001639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
THREADED ROD 6MM X 30MM (USE W M6 NUT) 4933-1-030
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
6001638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.03 |
| Max. Negotiated Rate |
$687.24 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$448.20
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
THREADED ROD 6MM X 30MM (USE W M6 NUT) 4933-1-030
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
6001638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.16 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Aetna Managed Medicare |
$209.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$485.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.02
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.25
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$485.55
|
| Rate for Payer: Quartz Medicare Advantage |
$448.20
|
| Rate for Payer: The Alliance Commercial |
$2,988.00
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
THREADED ROD 6MM X 80MM (USE W M6 NUT) 4933-1-080
|
Facility
|
OP
|
$717.29
|
|
| Hospital Charge Code |
6240149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.84 |
| Max. Negotiated Rate |
$2,869.16 |
| Rate for Payer: Aetna Commercial |
$645.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$616.87
|
| Rate for Payer: Aetna Managed Medicare |
$200.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$466.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$358.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$344.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.16
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cigna Commercial |
$659.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.40
|
| Rate for Payer: Health EOS Commercial |
$638.39
|
| Rate for Payer: HFN Commercial |
$659.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$537.97
|
| Rate for Payer: Multiplan Commercial |
$573.83
|
| Rate for Payer: NAPHCARE Commercial |
$430.37
|
| Rate for Payer: Preferred Network Access Commercial |
$659.91
|
| Rate for Payer: Quartz Beloit One Network |
$351.47
|
| Rate for Payer: Quartz Commercial |
$466.24
|
| Rate for Payer: Quartz Medicare Advantage |
$430.37
|
| Rate for Payer: The Alliance Commercial |
$2,869.16
|
| Rate for Payer: WEA Trust Commercial |
$394.51
|
| Rate for Payer: WPS Commercial |
$531.30
|
|
|
THREADED ROD 6MM X 80MM (USE W M6 NUT) 4933-1-080
|
Facility
|
IP
|
$717.29
|
|
| Hospital Charge Code |
6240149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.47 |
| Max. Negotiated Rate |
$659.91 |
| Rate for Payer: Aetna Commercial |
$645.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$616.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.16
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cigna Commercial |
$659.91
|
| Rate for Payer: Health EOS Commercial |
$638.39
|
| Rate for Payer: HFN Commercial |
$659.91
|
| Rate for Payer: Multiplan Commercial |
$573.83
|
| Rate for Payer: NAPHCARE Commercial |
$430.37
|
| Rate for Payer: Preferred Network Access Commercial |
$659.91
|
| Rate for Payer: Quartz Beloit One Network |
$351.47
|
| Rate for Payer: Quartz Commercial |
$430.37
|
| Rate for Payer: WEA Trust Commercial |
$394.51
|
| Rate for Payer: WPS Commercial |
$531.30
|
|
|
THREADED ROD LENGTH 200MM 4933-1-200
|
Facility
|
OP
|
$863.00
|
|
| Hospital Charge Code |
6201075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.64 |
| Max. Negotiated Rate |
$3,452.00 |
| Rate for Payer: Aetna Commercial |
$776.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$742.18
|
| Rate for Payer: Aetna Managed Medicare |
$241.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$560.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$431.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$414.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.39
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$793.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$482.93
|
| Rate for Payer: Health EOS Commercial |
$768.07
|
| Rate for Payer: HFN Commercial |
$793.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$647.25
|
| Rate for Payer: Multiplan Commercial |
$690.40
|
| Rate for Payer: NAPHCARE Commercial |
$517.80
|
| Rate for Payer: Preferred Network Access Commercial |
$793.96
|
| Rate for Payer: Quartz Beloit One Network |
$422.87
|
| Rate for Payer: Quartz Commercial |
$560.95
|
| Rate for Payer: Quartz Medicare Advantage |
$517.80
|
| Rate for Payer: The Alliance Commercial |
$3,452.00
|
| Rate for Payer: WEA Trust Commercial |
$474.65
|
| Rate for Payer: WPS Commercial |
$639.22
|
|
