|
TOGA HOOD T7 PLUS ANTI-REFLECTIVE LENS 0416-801-200
|
Facility
|
IP
|
$499.00
|
|
| Hospital Charge Code |
6181770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
TOGA HOOD T7 PLUS PEEL-AWAY 0416-801-100
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
6181769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
TOGA HOOD T7 PLUS PEEL-AWAY 0416-801-100
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
6181769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
TOGA T7 PLUS ANTI-REFLECTIVE LENS 2X 0416-841-200
|
Facility
|
IP
|
$1,154.00
|
|
| Hospital Charge Code |
6181917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.46 |
| Max. Negotiated Rate |
$1,061.68 |
| Rate for Payer: Aetna Commercial |
$1,038.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$992.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.62
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,061.68
|
| Rate for Payer: Health EOS Commercial |
$1,027.06
|
| Rate for Payer: HFN Commercial |
$1,061.68
|
| Rate for Payer: Multiplan Commercial |
$923.20
|
| Rate for Payer: NAPHCARE Commercial |
$692.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.68
|
| Rate for Payer: Quartz Beloit One Network |
$565.46
|
| Rate for Payer: Quartz Commercial |
$692.40
|
| Rate for Payer: WEA Trust Commercial |
$634.70
|
| Rate for Payer: WPS Commercial |
$854.77
|
|
|
TOGA T7 PLUS ANTI-REFLECTIVE LENS 2X 0416-841-200
|
Facility
|
OP
|
$1,154.00
|
|
| Hospital Charge Code |
6181917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$323.12 |
| Max. Negotiated Rate |
$4,616.00 |
| Rate for Payer: Aetna Commercial |
$1,038.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$992.44
|
| Rate for Payer: Aetna Managed Medicare |
$323.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$750.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$577.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.62
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,061.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.78
|
| Rate for Payer: Health EOS Commercial |
$1,027.06
|
| Rate for Payer: HFN Commercial |
$1,061.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$865.50
|
| Rate for Payer: Multiplan Commercial |
$923.20
|
| Rate for Payer: NAPHCARE Commercial |
$692.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.68
|
| Rate for Payer: Quartz Beloit One Network |
$565.46
|
| Rate for Payer: Quartz Commercial |
$750.10
|
| Rate for Payer: Quartz Medicare Advantage |
$692.40
|
| Rate for Payer: The Alliance Commercial |
$4,616.00
|
| Rate for Payer: WEA Trust Commercial |
$634.70
|
| Rate for Payer: WPS Commercial |
$854.77
|
|
|
TOGA T7 PLUS ANTI-REFLECTIVE LENS XL 0416-831-200
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
6181918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$287.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.59
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$666.25
|
| Rate for Payer: Quartz Medicare Advantage |
$615.00
|
| Rate for Payer: The Alliance Commercial |
$4,100.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
TOGA T7 PLUS ANTI-REFLECTIVE LENS XL 0416-831-200
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
6181918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$943.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$615.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
TOGA T7 PLUS PEEL-AWAY 2X 0416-841-100
|
Facility
|
OP
|
$1,363.00
|
|
| Hospital Charge Code |
6181771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.64 |
| Max. Negotiated Rate |
$5,452.00 |
| Rate for Payer: Aetna Commercial |
$1,226.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,172.18
|
| Rate for Payer: Aetna Managed Medicare |
$381.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$885.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$681.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$654.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$722.39
|
| Rate for Payer: Cash Price |
$408.90
|
| Rate for Payer: Cigna Commercial |
$1,253.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$762.73
|
| Rate for Payer: Health EOS Commercial |
$1,213.07
|
| Rate for Payer: HFN Commercial |
$1,253.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,022.25
|
| Rate for Payer: Multiplan Commercial |
$1,090.40
|
| Rate for Payer: NAPHCARE Commercial |
$817.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,253.96
|
| Rate for Payer: Quartz Beloit One Network |
$667.87
|
| Rate for Payer: Quartz Commercial |
$885.95
|
| Rate for Payer: Quartz Medicare Advantage |
$817.80
|
| Rate for Payer: The Alliance Commercial |
$5,452.00
|
| Rate for Payer: WEA Trust Commercial |
$749.65
|
| Rate for Payer: WPS Commercial |
$1,009.57
|
|
|
TOGA T7 PLUS PEEL-AWAY 2X 0416-841-100
|
Facility
|
IP
|
$1,363.00
|
|
| Hospital Charge Code |
6181771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.87 |
| Max. Negotiated Rate |
$1,253.96 |
| Rate for Payer: Aetna Commercial |
$1,226.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,172.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$722.39
|
| Rate for Payer: Cash Price |
$408.90
|
| Rate for Payer: Cigna Commercial |
$1,253.96
|
| Rate for Payer: Health EOS Commercial |
$1,213.07
|
| Rate for Payer: HFN Commercial |
$1,253.96
|
| Rate for Payer: Multiplan Commercial |
$1,090.40
|
| Rate for Payer: NAPHCARE Commercial |
$817.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,253.96
|
| Rate for Payer: Quartz Beloit One Network |
$667.87
|
| Rate for Payer: Quartz Commercial |
$817.80
|
| Rate for Payer: WEA Trust Commercial |
$749.65
|
| Rate for Payer: WPS Commercial |
$1,009.57
|
|
|
TOGA ZIPPERED REGULAR T5 0400-830-000
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
2966092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$967.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Aetna Managed Medicare |
$301.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$698.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$537.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.75
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$989.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$601.57
|
| Rate for Payer: Health EOS Commercial |
$956.75
|
| Rate for Payer: HFN Commercial |
$989.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.25
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: NAPHCARE Commercial |
$645.00
|
| Rate for Payer: Preferred Network Access Commercial |
$989.00
|
| Rate for Payer: Quartz Beloit One Network |
$526.75
|
| Rate for Payer: Quartz Commercial |
$698.75
|
| Rate for Payer: Quartz Medicare Advantage |
$645.00
|
| Rate for Payer: The Alliance Commercial |
$4,300.00
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
TOGA ZIPPERED REGULAR T5 0400-830-000
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
2966092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.75 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Aetna Commercial |
$967.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.75
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$989.00
|
| Rate for Payer: Health EOS Commercial |
$956.75
|
| Rate for Payer: HFN Commercial |
$989.00
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: NAPHCARE Commercial |
$645.00
|
| Rate for Payer: Preferred Network Access Commercial |
$989.00
|
| Rate for Payer: Quartz Beloit One Network |
$526.75
|
| Rate for Payer: Quartz Commercial |
$645.00
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
TOGA ZIPPERED X-LARGE T-5 0400-850-000
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2966093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.33 |
| Max. Negotiated Rate |
$1,027.64 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$670.20
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
TOGA ZIPPERED X-LARGE T-5 0400-850-000
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2966093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.76 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Aetna Commercial |
$1,005.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Aetna Managed Medicare |
$312.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$558.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.01
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,027.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.07
|
| Rate for Payer: Health EOS Commercial |
$994.13
|
| Rate for Payer: HFN Commercial |
$1,027.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$837.75
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: NAPHCARE Commercial |
$670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.64
|
| Rate for Payer: Quartz Beloit One Network |
$547.33
|
| Rate for Payer: Quartz Commercial |
$726.05
|
| Rate for Payer: Quartz Medicare Advantage |
$670.20
|
| Rate for Payer: The Alliance Commercial |
$4,468.00
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
TONGUE PADDED #ACM-9187
|
Facility
|
IP
|
$402.00
|
|
| Hospital Charge Code |
2971080
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$369.84 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$241.20
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
TONGUE PADDED #ACM-9187
|
Facility
|
OP
|
$402.00
|
|
| Hospital Charge Code |
2971080
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Aetna Managed Medicare |
$112.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.96
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.50
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$261.30
|
| Rate for Payer: Quartz Medicare Advantage |
$241.20
|
| Rate for Payer: The Alliance Commercial |
$1,608.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
TONSIL BLEED
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
TONSIL BLEED
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
TONSILLECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
TONSILLECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
TONSILLECTOMY/ADENOIDECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
TONSILLECTOMY/ADENOIDECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 42821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$23,153.12
|
|
|
Service Code
|
CPT 42820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$23,153.12 |
| Rate for Payer: Aetna Managed Medicare |
$5,788.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,788.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,788.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,788.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,532.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,788.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,788.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,788.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,788.28
|
| Rate for Payer: NAPHCARE Commercial |
$8,682.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,788.28
|
| Rate for Payer: The Alliance Commercial |
$23,153.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,788.28
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,788.28
|
|
|
TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 42826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
TONSILLECTOMY, PRIMARY OR SECONDARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$23,153.12
|
|
|
Service Code
|
CPT 42825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$23,153.12 |
| Rate for Payer: Aetna Managed Medicare |
$5,788.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,788.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,788.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,788.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,532.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,788.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,788.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,788.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,788.28
|
| Rate for Payer: NAPHCARE Commercial |
$8,682.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,788.28
|
| Rate for Payer: The Alliance Commercial |
$23,153.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,788.28
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,788.28
|
|
