|
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 |
$94.00 |
| Max. Negotiated Rate |
$3,120.10 |
| Rate for Payer: Aetna Commercial |
$3,120.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,824.52
|
| 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 |
$3,120.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.59
|
| Rate for Payer: Health EOS Commercial |
$2,988.73
|
| Rate for Payer: HFN Commercial |
$3,120.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$2,627.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,120.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,445.10
|
| Rate for Payer: Quartz Commercial |
$1,872.06
|
| Rate for Payer: The Alliance Commercial |
$1,642.16
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: WEA Trust Commercial |
$1,806.38
|
| Rate for Payer: WPS Commercial |
$2,432.61
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$660.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
|
|
Thoracentesis Performed By
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2844884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,087.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,039.29
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$785.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$604.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$580.07
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| 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 |
$1,111.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$1,075.55
|
| Rate for Payer: HFN Commercial |
$1,111.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$966.78
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.80
|
| Rate for Payer: Quartz Beloit One Network |
$592.16
|
| Rate for Payer: Quartz Commercial |
$785.51
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$664.66
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$895.09
|
|
|
Thoracentesis Performed By
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
2844884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$592.16 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Aetna Commercial |
$1,087.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,039.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.49
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,111.80
|
| Rate for Payer: Health EOS Commercial |
$1,075.55
|
| Rate for Payer: HFN Commercial |
$1,111.80
|
| Rate for Payer: Multiplan Commercial |
$966.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.80
|
| Rate for Payer: Quartz Beloit One Network |
$592.16
|
| Rate for Payer: Quartz Commercial |
$725.09
|
| Rate for Payer: WEA Trust Commercial |
$664.66
|
| Rate for Payer: WPS Commercial |
$895.09
|
|
|
THORACENTESIS, RELATED BIOPSY AND PLEURAL DRAINAGE PROCEDURES
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
EAPG 00068
|
| Min. Negotiated Rate |
$414.51 |
| Max. Negotiated Rate |
$431.09 |
| Rate for Payer: Anthem Medicaid |
$414.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$414.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$414.51
|
| Rate for Payer: Dean Health Medicaid |
$414.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$414.51
|
| Rate for Payer: Managed Health Services Medicaid |
$431.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$414.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$414.51
|
| Rate for Payer: United Healthcare Medicaid |
$414.51
|
|
|
Thoracentesis w/Imag 32555
|
Professional
|
Both
|
$1,860.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
3157536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$1,837.68 |
| Rate for Payer: Aetna Commercial |
$1,837.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,663.58
|
| Rate for Payer: Aetna Managed Medicare |
$91.77
|
| Rate for Payer: Anthem Medicare Advantage |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.77
|
| 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 |
$1,837.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.77
|
| Rate for Payer: Health EOS Commercial |
$1,760.30
|
| Rate for Payer: HFN Commercial |
$1,837.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$388.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.77
|
| Rate for Payer: Multiplan Commercial |
$1,547.52
|
| Rate for Payer: NAPHCARE Commercial |
$137.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.68
|
| Rate for Payer: Quartz Beloit One Network |
$851.14
|
| Rate for Payer: Quartz Commercial |
$1,102.61
|
| Rate for Payer: Quartz Medicare Advantage |
$91.77
|
| Rate for Payer: The Alliance Commercial |
$390.02
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.77
|
| Rate for Payer: WEA Trust Commercial |
$1,063.92
|
| Rate for Payer: WPS Commercial |
$412.96
|
|
|
Thoracentesis w/Imaging
|
Facility
|
IP
|
$2,361.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
5605764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.17 |
| Max. Negotiated Rate |
$2,259.00 |
| Rate for Payer: Aetna Commercial |
$2,209.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,111.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.38
|
| Rate for Payer: Cash Price |
$708.30
|
| Rate for Payer: Cigna Commercial |
$2,259.00
|
| Rate for Payer: Health EOS Commercial |
$2,185.34
|
| Rate for Payer: HFN Commercial |
$2,259.00
|
| Rate for Payer: Multiplan Commercial |
$1,964.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,203.17
|
| Rate for Payer: Quartz Commercial |
$1,473.26
|
| Rate for Payer: WEA Trust Commercial |
$1,350.49
|
| Rate for Payer: WPS Commercial |
$1,818.68
|
|
|
Thoracentesis w/Imaging
|
Facility
|
OP
|
$2,361.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
5605764
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,209.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,111.68
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,596.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,227.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,178.61
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| 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 |
$2,259.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$2,185.34
|
| Rate for Payer: HFN Commercial |
$2,259.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$1,964.35
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,203.17
|
| Rate for Payer: Quartz Commercial |
$1,596.04
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,350.49
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$1,818.68
|
|
|
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 |
$76.71 |
| Max. Negotiated Rate |
$1,560.05 |
| Rate for Payer: Aetna Commercial |
$1,560.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.26
|
| Rate for Payer: Aetna Managed Medicare |
$76.71
|
| Rate for Payer: Anthem Medicare Advantage |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.71
|
| 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 |
$1,560.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.71
|
| Rate for Payer: Health EOS Commercial |
$1,494.37
|
| Rate for Payer: HFN Commercial |
$1,560.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$1,313.73
|
| Rate for Payer: NAPHCARE Commercial |
$115.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.05
|
| Rate for Payer: Quartz Beloit One Network |
$722.55
|
| Rate for Payer: Quartz Commercial |
$936.03
|
| Rate for Payer: Quartz Medicare Advantage |
$76.71
|
| Rate for Payer: The Alliance Commercial |
$326.02
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.71
|
| Rate for Payer: WEA Trust Commercial |
$903.19
|
| Rate for Payer: WPS Commercial |
$345.20
|
|
|
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 |
$392.70 |
| Max. Negotiated Rate |
$1,570.82 |
| Rate for Payer: Aetna Commercial |
$883.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$844.31
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$638.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$490.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$471.24
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$903.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$549.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$873.77
|
| Rate for Payer: HFN Commercial |
$903.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$785.41
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$903.22
|
| Rate for Payer: Quartz Beloit One Network |
$481.06
|
| Rate for Payer: Quartz Commercial |
$638.14
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: United Healthcare PPO |
$736.32
|
| Rate for Payer: WEA Trust Commercial |
$539.97
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$727.16
|
|
|
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 |
$481.06 |
| Max. Negotiated Rate |
$903.22 |
| Rate for Payer: Aetna Commercial |
$883.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$844.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.33
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cigna Commercial |
$903.22
|
| Rate for Payer: Health EOS Commercial |
$873.77
|
| Rate for Payer: HFN Commercial |
$903.22
|
| Rate for Payer: Multiplan Commercial |
$785.41
|
| Rate for Payer: Preferred Network Access Commercial |
$903.22
|
| Rate for Payer: Quartz Beloit One Network |
$481.06
|
| Rate for Payer: Quartz Commercial |
$589.06
|
| Rate for Payer: WEA Trust Commercial |
$539.97
|
| Rate for Payer: WPS Commercial |
$727.16
|
|
|
THORACIC SURGERY, VIDEO ASSISTED (VATS)
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2950344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
THORACIC SURGERY, VIDEO ASSISTED (VATS)
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2950344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
THORACOLUMBAR SYMPATHECTOMY
|
Facility
|
IP
|
$7,778.00
|
|
| Hospital Charge Code |
2960399
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,963.67 |
| Max. Negotiated Rate |
$7,441.99 |
| Rate for Payer: Aetna Commercial |
$7,280.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,956.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,287.23
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,441.99
|
| Rate for Payer: Health EOS Commercial |
$7,199.32
|
| Rate for Payer: HFN Commercial |
$7,441.99
|
| Rate for Payer: Multiplan Commercial |
$6,471.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,441.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,963.67
|
| Rate for Payer: Quartz Commercial |
$4,853.47
|
| Rate for Payer: WEA Trust Commercial |
$4,449.02
|
| Rate for Payer: WPS Commercial |
$5,991.39
|
|
|
THORACOLUMBAR SYMPATHECTOMY
|
Facility
|
OP
|
$7,778.00
|
|
| Hospital Charge Code |
2960399
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,264.95 |
| Max. Negotiated Rate |
$7,441.99 |
| Rate for Payer: Aetna Commercial |
$7,280.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,956.64
|
| Rate for Payer: Aetna Managed Medicare |
$2,264.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,257.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,044.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,882.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,287.23
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,441.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,526.80
|
| Rate for Payer: Health EOS Commercial |
$7,199.32
|
| Rate for Payer: HFN Commercial |
$7,441.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,066.84
|
| Rate for Payer: Multiplan Commercial |
$6,471.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,853.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,441.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,963.67
|
| Rate for Payer: Quartz Commercial |
$5,257.93
|
| Rate for Payer: Quartz Medicare Advantage |
$4,853.47
|
| Rate for Payer: The Alliance Commercial |
$4,044.56
|
| Rate for Payer: WEA Trust Commercial |
$4,449.02
|
| Rate for Payer: WPS Commercial |
$5,991.39
|
|
|
THORACOTOMY/BLEB RESECTION/DECORTICATION/LUNG WEDGE RESECTION /PLICATION
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
THORACOTOMY/BLEB RESECTION/DECORTICATION/LUNG WEDGE RESECTION /PLICATION
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
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 |
$439.78 |
| Max. Negotiated Rate |
$825.72 |
| Rate for Payer: Aetna Commercial |
$807.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$771.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.69
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$825.72
|
| Rate for Payer: Health EOS Commercial |
$798.79
|
| Rate for Payer: HFN Commercial |
$825.72
|
| Rate for Payer: Multiplan Commercial |
$718.02
|
| Rate for Payer: Preferred Network Access Commercial |
$825.72
|
| Rate for Payer: Quartz Beloit One Network |
$439.78
|
| Rate for Payer: Quartz Commercial |
$538.51
|
| Rate for Payer: WEA Trust Commercial |
$493.64
|
| Rate for Payer: WPS Commercial |
$664.77
|
|
|
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 |
$251.31 |
| Max. Negotiated Rate |
$825.72 |
| Rate for Payer: Aetna Commercial |
$807.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$771.87
|
| Rate for Payer: Aetna Managed Medicare |
$251.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$448.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$430.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.69
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$825.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.27
|
| Rate for Payer: Health EOS Commercial |
$798.79
|
| Rate for Payer: HFN Commercial |
$825.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.14
|
| Rate for Payer: Multiplan Commercial |
$718.02
|
| Rate for Payer: NAPHCARE Commercial |
$538.51
|
| Rate for Payer: Preferred Network Access Commercial |
$825.72
|
| Rate for Payer: Quartz Beloit One Network |
$439.78
|
| Rate for Payer: Quartz Commercial |
$583.39
|
| Rate for Payer: Quartz Medicare Advantage |
$538.51
|
| Rate for Payer: The Alliance Commercial |
$448.76
|
| Rate for Payer: WEA Trust Commercial |
$493.64
|
| Rate for Payer: WPS Commercial |
$664.77
|
|
|
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 |
$457.62 |
| Max. Negotiated Rate |
$859.21 |
| Rate for Payer: Aetna Commercial |
$840.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$494.98
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$859.21
|
| Rate for Payer: Health EOS Commercial |
$831.19
|
| Rate for Payer: HFN Commercial |
$859.21
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: Preferred Network Access Commercial |
$859.21
|
| Rate for Payer: Quartz Beloit One Network |
$457.62
|
| Rate for Payer: Quartz Commercial |
$560.35
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
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 |
$261.50 |
| Max. Negotiated Rate |
$859.21 |
| Rate for Payer: Aetna Commercial |
$840.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Aetna Managed Medicare |
$261.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$607.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$466.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$448.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$494.98
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$859.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.64
|
| Rate for Payer: Health EOS Commercial |
$831.19
|
| Rate for Payer: HFN Commercial |
$859.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.44
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: NAPHCARE Commercial |
$560.35
|
| Rate for Payer: Preferred Network Access Commercial |
$859.21
|
| Rate for Payer: Quartz Beloit One Network |
$457.62
|
| Rate for Payer: Quartz Commercial |
$607.05
|
| Rate for Payer: Quartz Medicare Advantage |
$560.35
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
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 |
$217.53 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$217.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.66
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$466.13
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$466.13
|
| Rate for Payer: The Alliance Commercial |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
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 |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
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 |
$208.87 |
| Max. Negotiated Rate |
$686.30 |
| Rate for Payer: Aetna Commercial |
$671.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$641.54
|
| Rate for Payer: Aetna Managed Medicare |
$208.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$484.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$372.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.37
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cigna Commercial |
$686.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$417.46
|
| Rate for Payer: Health EOS Commercial |
$663.92
|
| Rate for Payer: HFN Commercial |
$686.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$559.49
|
| Rate for Payer: Multiplan Commercial |
$596.79
|
| Rate for Payer: NAPHCARE Commercial |
$447.59
|
| Rate for Payer: Preferred Network Access Commercial |
$686.30
|
| Rate for Payer: Quartz Beloit One Network |
$365.53
|
| Rate for Payer: Quartz Commercial |
$484.89
|
| Rate for Payer: Quartz Medicare Advantage |
$447.59
|
| Rate for Payer: The Alliance Commercial |
$372.99
|
| Rate for Payer: WEA Trust Commercial |
$410.29
|
| Rate for Payer: WPS Commercial |
$552.53
|
|
|
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 |
$365.53 |
| Max. Negotiated Rate |
$686.30 |
| Rate for Payer: Aetna Commercial |
$671.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$641.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.37
|
| Rate for Payer: Cash Price |
$215.19
|
| Rate for Payer: Cigna Commercial |
$686.30
|
| Rate for Payer: Health EOS Commercial |
$663.92
|
| Rate for Payer: HFN Commercial |
$686.30
|
| Rate for Payer: Multiplan Commercial |
$596.79
|
| Rate for Payer: Preferred Network Access Commercial |
$686.30
|
| Rate for Payer: Quartz Beloit One Network |
$365.53
|
| Rate for Payer: Quartz Commercial |
$447.59
|
| Rate for Payer: WEA Trust Commercial |
$410.29
|
| Rate for Payer: WPS Commercial |
$552.53
|
|
