|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
THORACOTOMY; WITH CARDIAC MASSAGE
|
Facility
|
OP
|
$16,970.72
|
|
|
Service Code
|
CPT 32160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,872.11 |
| Max. Negotiated Rate |
$16,970.72 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$2,872.11
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
|
|
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 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 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 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 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 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 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
|
|
|
THREADED ROD LENGTH 200MM 4933-1-200
|
Facility
|
IP
|
$863.00
|
|
| Hospital Charge Code |
6201075
|
|
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 LENGTH 200MM 4933-1-200
|
Facility
|
OP
|
$863.00
|
|
| Hospital Charge Code |
6201075
|
|
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
|
|
|
Throat Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Throat Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.45
|
|
|
Throat Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Throgen 0.9 mg Charge
|
Professional
|
Both
|
$6,790.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
2958852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,103.26 |
| Max. Negotiated Rate |
$6,708.52 |
| Rate for Payer: Aetna Commercial |
$6,708.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,072.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,245.01
|
| Rate for Payer: Anthem Medicare Advantage |
$2,245.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,245.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,245.01
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$6,708.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,210.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,103.26
|
| Rate for Payer: Health EOS Commercial |
$6,426.06
|
| Rate for Payer: HFN Commercial |
$6,708.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,694.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,694.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,245.01
|
| Rate for Payer: Multiplan Commercial |
$5,649.28
|
| Rate for Payer: NAPHCARE Commercial |
$3,367.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,708.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,107.10
|
| Rate for Payer: Quartz Commercial |
$4,025.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,245.01
|
| Rate for Payer: The Alliance Commercial |
$6,173.77
|
| Rate for Payer: United Healthcare Medicaid |
$2,210.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,245.01
|
| Rate for Payer: WEA Trust Commercial |
$3,883.88
|
| Rate for Payer: WPS Commercial |
$5,258.15
|
|
|
Throgen 0.9 mg Charge
|
Facility
|
OP
|
$6,790.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
2958852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,245.01 |
| Max. Negotiated Rate |
$8,980.03 |
| Rate for Payer: Aetna Commercial |
$6,355.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,072.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,245.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,590.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,530.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,389.57
|
| Rate for Payer: Anthem Medicare Advantage |
$2,245.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,742.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,245.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,245.01
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$6,496.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,245.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,782.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,245.01
|
| Rate for Payer: Health EOS Commercial |
$6,284.82
|
| Rate for Payer: HFN Commercial |
$6,496.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,351.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,245.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,245.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,245.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,245.01
|
| Rate for Payer: Multiplan Commercial |
$5,649.28
|
| Rate for Payer: NAPHCARE Commercial |
$3,367.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,496.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,460.18
|
| Rate for Payer: Quartz Commercial |
$4,590.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,245.01
|
| Rate for Payer: The Alliance Commercial |
$8,980.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,245.01
|
| Rate for Payer: WEA Trust Commercial |
$3,883.88
|
| Rate for Payer: Wellcare Medicare |
$2,245.01
|
| Rate for Payer: WPS Commercial |
$5,258.15
|
|
|
Throgen 0.9 mg Charge
|
Facility
|
IP
|
$6,790.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
2958852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,460.18 |
| Max. Negotiated Rate |
$6,496.67 |
| Rate for Payer: Aetna Commercial |
$6,355.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,072.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,742.65
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$6,496.67
|
| Rate for Payer: Health EOS Commercial |
$6,284.82
|
| Rate for Payer: HFN Commercial |
$6,496.67
|
| Rate for Payer: Multiplan Commercial |
$5,649.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,496.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,460.18
|
| Rate for Payer: Quartz Commercial |
$4,236.96
|
| Rate for Payer: WEA Trust Commercial |
$3,883.88
|
| Rate for Payer: WPS Commercial |
$5,230.34
|
|
|
THROMBECTOMY CATHETER SOLENT PEOXI 109676-001
|
Facility
|
IP
|
$9,739.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,962.99 |
| Max. Negotiated Rate |
$9,318.28 |
| Rate for Payer: Aetna Commercial |
$9,115.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,710.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,368.14
|
| Rate for Payer: Cash Price |
$2,921.70
|
| Rate for Payer: Cigna Commercial |
$9,318.28
|
| Rate for Payer: Health EOS Commercial |
$9,014.42
|
| Rate for Payer: HFN Commercial |
$9,318.28
|
| Rate for Payer: Multiplan Commercial |
$8,102.85
|
| Rate for Payer: Preferred Network Access Commercial |
$9,318.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,962.99
|
| Rate for Payer: Quartz Commercial |
$6,077.14
|
| Rate for Payer: WEA Trust Commercial |
$5,570.71
|
| Rate for Payer: WPS Commercial |
$7,501.95
|
|
