|
Verigene Gram Positive PCR Report
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
VERSAJET 45DEG HANDSET 50637
|
Facility
OP
|
$6,239.00
|
|
| Hospital Charge Code |
2966058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,746.92 |
| Max. Negotiated Rate |
$24,956.00 |
| Rate for Payer: Aetna Commercial |
$5,615.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,365.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,746.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,055.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,119.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,994.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,306.67
|
| Rate for Payer: Cash Price |
$1,871.70
|
| Rate for Payer: Cigna Commercial |
$5,739.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,491.34
|
| Rate for Payer: Health EOS Commercial |
$5,552.71
|
| Rate for Payer: HFN Commercial |
$5,739.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,679.25
|
| Rate for Payer: Multiplan Commercial |
$4,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,743.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,739.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,057.11
|
| Rate for Payer: Quartz Commercial |
$4,055.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,743.40
|
| Rate for Payer: The Alliance Commercial |
$24,956.00
|
| Rate for Payer: WEA Trust Commercial |
$3,431.45
|
| Rate for Payer: WPS Commercial |
$4,621.23
|
|
|
VERSAJET 45DEG HANDSET 50637
|
Facility
IP
|
$6,239.00
|
|
| Hospital Charge Code |
2966058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,057.11 |
| Max. Negotiated Rate |
$5,739.88 |
| Rate for Payer: Aetna Commercial |
$5,615.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,306.67
|
| Rate for Payer: Cash Price |
$1,871.70
|
| Rate for Payer: Cigna Commercial |
$5,739.88
|
| Rate for Payer: Health EOS Commercial |
$5,552.71
|
| Rate for Payer: HFN Commercial |
$5,739.88
|
| Rate for Payer: Multiplan Commercial |
$4,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,743.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,739.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,057.11
|
| Rate for Payer: Quartz Commercial |
$3,743.40
|
| Rate for Payer: WEA Trust Commercial |
$3,431.45
|
| Rate for Payer: WPS Commercial |
$4,621.23
|
|
|
VERSYS 13 CR CALCAR FEM STEM
|
Facility
IP
|
$35,241.00
|
|
| Hospital Charge Code |
2967542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,268.09 |
| Max. Negotiated Rate |
$32,421.72 |
| Rate for Payer: Aetna Commercial |
$31,716.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,677.73
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cigna Commercial |
$32,421.72
|
| Rate for Payer: Health EOS Commercial |
$31,364.49
|
| Rate for Payer: HFN Commercial |
$32,421.72
|
| Rate for Payer: Multiplan Commercial |
$28,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$21,144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$32,421.72
|
| Rate for Payer: Quartz Beloit One Network |
$17,268.09
|
| Rate for Payer: Quartz Commercial |
$21,144.60
|
| Rate for Payer: WEA Trust Commercial |
$19,382.55
|
| Rate for Payer: WPS Commercial |
$26,103.01
|
|
|
VERSYS 13 CR CALCAR FEM STEM
|
Facility
OP
|
$35,241.00
|
|
| Hospital Charge Code |
2967542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,867.48 |
| Max. Negotiated Rate |
$140,964.00 |
| Rate for Payer: Aetna Commercial |
$31,716.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,307.26
|
| Rate for Payer: Aetna Managed Medicare |
$9,867.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,906.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,620.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,915.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,677.73
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cigna Commercial |
$32,421.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,720.86
|
| Rate for Payer: Health EOS Commercial |
$31,364.49
|
| Rate for Payer: HFN Commercial |
$32,421.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,430.75
|
| Rate for Payer: Multiplan Commercial |
$28,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$21,144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$32,421.72
|
| Rate for Payer: Quartz Beloit One Network |
$17,268.09
|
| Rate for Payer: Quartz Commercial |
$22,906.65
|
| Rate for Payer: Quartz Medicare Advantage |
$21,144.60
|
| Rate for Payer: The Alliance Commercial |
$140,964.00
|
| Rate for Payer: WEA Trust Commercial |
$19,382.55
|
| Rate for Payer: WPS Commercial |
$26,103.01
|
|
|
Vertebroplasty addl inject 22512
|
Professional
|
$2,163.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
6181379
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$189.04 |
| Max. Negotiated Rate |
$2,054.85 |
| Rate for Payer: Aetna Commercial |
$2,054.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,860.18
|
| Rate for Payer: Aetna Managed Medicare |
$189.04
|
| Rate for Payer: Anthem Medicare Advantage |
$189.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$189.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$189.04
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cigna Commercial |
$2,054.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,081.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.04
|
| Rate for Payer: Health EOS Commercial |
$1,968.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$679.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$679.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$189.04
|
| Rate for Payer: Multiplan Commercial |
$1,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,054.85
|
| Rate for Payer: Quartz Beloit One Network |
$951.72
|
| Rate for Payer: Quartz Commercial |
$1,232.91
|
| Rate for Payer: Quartz Medicare Advantage |
$189.04
|
| Rate for Payer: The Alliance Commercial |
$803.42
|
| Rate for Payer: United Healthcare Medicaid |
$743.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.04
|
| Rate for Payer: WEA Trust Commercial |
$1,189.65
|
| Rate for Payer: WPS Commercial |
$850.68
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC
|
Facility
OP
|
$2,293.00
|
|
| Hospital Charge Code |
6180099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$642.04 |
| Max. Negotiated Rate |
$9,172.00 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Aetna Managed Medicare |
$642.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,490.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.16
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,719.75
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,490.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,375.80
|
| Rate for Payer: The Alliance Commercial |
$9,172.00
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC
|
Facility
IP
|
$2,293.00
|
|
| Hospital Charge Code |
6180099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,123.57 |
| Max. Negotiated Rate |
$2,109.56 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,375.80
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC ADD LEVEL
|
Facility
IP
|
$1,165.00
|
|
| Hospital Charge Code |
6180097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.85 |
| Max. Negotiated Rate |
$1,071.80 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$699.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC ADD LEVEL
|
Facility
OP
|
$1,165.00
|
|
| Hospital Charge Code |
6180097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$4,660.00 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.90
|
| Rate for Payer: Aetna Managed Medicare |
$326.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.93
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.75
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$757.25
|
| Rate for Payer: Quartz Medicare Advantage |
$699.00
|
| Rate for Payer: The Alliance Commercial |
$4,660.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL
|
Facility
IP
|
$2,133.00
|
|
| Hospital Charge Code |
6180098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.17 |
| Max. Negotiated Rate |
$1,962.36 |
| Rate for Payer: Aetna Commercial |
$1,919.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.49
|
| Rate for Payer: Cash Price |
$639.90
|
| Rate for Payer: Cigna Commercial |
$1,962.36
|
| Rate for Payer: Health EOS Commercial |
$1,898.37
|
| Rate for Payer: HFN Commercial |
$1,962.36
|
| Rate for Payer: Multiplan Commercial |
$1,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.17
|
| Rate for Payer: Quartz Commercial |
$1,279.80
|
| Rate for Payer: WEA Trust Commercial |
$1,173.15
|
| Rate for Payer: WPS Commercial |
$1,579.91
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL
|
Facility
OP
|
$2,133.00
|
|
| Hospital Charge Code |
6180098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.24 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Aetna Commercial |
$1,919.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.38
|
| Rate for Payer: Aetna Managed Medicare |
$597.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,386.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.49
|
| Rate for Payer: Cash Price |
$639.90
|
| Rate for Payer: Cigna Commercial |
$1,962.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.63
|
| Rate for Payer: Health EOS Commercial |
$1,898.37
|
| Rate for Payer: HFN Commercial |
$1,962.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.75
|
| Rate for Payer: Multiplan Commercial |
$1,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.17
|
| Rate for Payer: Quartz Commercial |
$1,386.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.80
|
| Rate for Payer: The Alliance Commercial |
$8,532.00
|
| Rate for Payer: WEA Trust Commercial |
$1,173.15
|
| Rate for Payer: WPS Commercial |
$1,579.91
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL ADD LEVEL
|
Facility
IP
|
$1,165.00
|
|
| Hospital Charge Code |
6180096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.85 |
| Max. Negotiated Rate |
$1,071.80 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$699.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL ADD LEVEL
|
Facility
OP
|
$1,165.00
|
|
| Hospital Charge Code |
6180096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$4,660.00 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.90
|
| Rate for Payer: Aetna Managed Medicare |
$326.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.93
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.75
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$757.25
|
| Rate for Payer: Quartz Medicare Advantage |
$699.00
|
| Rate for Payer: The Alliance Commercial |
$4,660.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
Very Long Chain Fatty Acids / 90559
|
Facility
OP
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$19.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.78
|
| Rate for Payer: Anthem Medicaid |
$20.41
|
| Rate for Payer: Anthem Medicare Advantage |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.75
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.41
|
| Rate for Payer: Dean Health Medicaid |
$20.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.75
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.75
|
| Rate for Payer: Managed Health Services Medicaid |
$21.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.62
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.41
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$19.75
|
| Rate for Payer: The Alliance Commercial |
$1,616.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.75
|
| Rate for Payer: United Healthcare PPO |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: Wellcare Medicare |
$19.75
|
| Rate for Payer: WMAP Medicaid |
$20.41
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
Very Long Chain Fatty Acids / 90559
|
Facility
IP
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
Very Long Chain Fatty Acids / 90559
|
Professional
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Aetna Commercial |
$383.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$19.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.75
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$383.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.75
|
| Rate for Payer: Health EOS Commercial |
$367.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.80
|
| Rate for Payer: Quartz Beloit One Network |
$177.76
|
| Rate for Payer: Quartz Commercial |
$230.28
|
| Rate for Payer: Quartz Medicare Advantage |
$19.75
|
| Rate for Payer: The Alliance Commercial |
$78.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.75
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$86.90
|
|
|
VESICOVAGINAL FISTULA CLOSURE
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
VESICOVAGINAL FISTULA CLOSURE
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
VESICULECTOMY
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
VESICULECTOMY
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP LARGE 4008-07
|
Facility
OP
|
$6,077.00
|
|
| Hospital Charge Code |
5298748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,701.56 |
| Max. Negotiated Rate |
$24,308.00 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,701.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,950.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,038.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,916.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,557.75
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,646.20
|
| Rate for Payer: The Alliance Commercial |
$24,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP LARGE 4008-07
|
Facility
IP
|
$6,077.00
|
|
| Hospital Charge Code |
5298748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP MEDIUM 4008-06
|
Facility
IP
|
$6,077.00
|
|
| Hospital Charge Code |
5298747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP MEDIUM 4008-06
|
Facility
OP
|
$6,077.00
|
|
| Hospital Charge Code |
5298747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,701.56 |
| Max. Negotiated Rate |
$24,308.00 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,701.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,950.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,038.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,916.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,557.75
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,646.20
|
| Rate for Payer: The Alliance Commercial |
$24,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
