|
VL Vein Mapping Bilateral
|
Professional
|
Both
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$2,349.35 |
| Rate for Payer: Aetna Commercial |
$2,349.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,349.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,483.80
|
| Rate for Payer: Health EOS Commercial |
$2,250.43
|
| Rate for Payer: HFN Commercial |
$2,349.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,349.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.12
|
| Rate for Payer: Quartz Commercial |
$1,409.61
|
| Rate for Payer: The Alliance Commercial |
$1,236.50
|
| Rate for Payer: United Healthcare Medicaid |
$108.68
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
VL Vein Mapping Bilateral
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,211.77 |
| Max. Negotiated Rate |
$2,275.16 |
| Rate for Payer: Aetna Commercial |
$2,225.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.69
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,275.16
|
| Rate for Payer: Health EOS Commercial |
$2,200.97
|
| Rate for Payer: HFN Commercial |
$2,275.16
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.77
|
| Rate for Payer: Quartz Commercial |
$1,483.80
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
VL Vein Mapping Unilateral
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483411
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Aetna Commercial |
$1,363.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,363.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.00
|
| Rate for Payer: Health EOS Commercial |
$1,305.85
|
| Rate for Payer: HFN Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.25
|
| Rate for Payer: Quartz Beloit One Network |
$631.40
|
| Rate for Payer: Quartz Commercial |
$817.95
|
| Rate for Payer: The Alliance Commercial |
$717.50
|
| Rate for Payer: United Healthcare Medicaid |
$108.68
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
VL Vein Mapping Unilateral
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483411
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,320.20 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,320.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,277.15
|
| Rate for Payer: HFN Commercial |
$1,320.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.20
|
| Rate for Payer: Quartz Beloit One Network |
$703.15
|
| Rate for Payer: Quartz Commercial |
$932.75
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$1,076.25
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
VL Vein Mapping Unilateral
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483411
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$703.15 |
| Max. Negotiated Rate |
$1,320.20 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.55
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,320.20
|
| Rate for Payer: Health EOS Commercial |
$1,277.15
|
| Rate for Payer: HFN Commercial |
$1,320.20
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.20
|
| Rate for Payer: Quartz Beloit One Network |
$703.15
|
| Rate for Payer: Quartz Commercial |
$861.00
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
VOCAL CORD STRIPPING
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960506
|
|
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
|
|
|
VOCAL CORD STRIPPING
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960506
|
|
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
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 10mm #BE 6010
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$672.60
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 10mm #BE 6010
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.88 |
| Max. Negotiated Rate |
$4,484.00 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Aetna Managed Medicare |
$313.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.31
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.75
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$728.65
|
| Rate for Payer: Quartz Medicare Advantage |
$672.60
|
| Rate for Payer: The Alliance Commercial |
$4,484.00
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 12mm #LP16-012
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$672.60
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 12mm #LP16-012
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.88 |
| Max. Negotiated Rate |
$4,484.00 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Aetna Managed Medicare |
$313.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.31
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.75
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$728.65
|
| Rate for Payer: Quartz Medicare Advantage |
$672.60
|
| Rate for Payer: The Alliance Commercial |
$4,484.00
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 14mm #BE 6011
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.88 |
| Max. Negotiated Rate |
$4,484.00 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Aetna Managed Medicare |
$313.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.31
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.75
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$728.65
|
| Rate for Payer: Quartz Medicare Advantage |
$672.60
|
| Rate for Payer: The Alliance Commercial |
$4,484.00
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 14mm #BE 6011
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$672.60
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 8mm #LP16-008
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.88 |
| Max. Negotiated Rate |
$4,484.00 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Aetna Managed Medicare |
$313.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.31
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.75
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$728.65
|
| Rate for Payer: Quartz Medicare Advantage |
$672.60
|
| Rate for Payer: The Alliance Commercial |
$4,484.00
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 8mm #LP16-008
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$672.60
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
Voiding Pressure Any Technique
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
3005558
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$542.40 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$1,017.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.80
|
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$734.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$565.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$542.40
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$1,039.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
| Rate for Payer: Health EOS Commercial |
$1,005.70
|
| Rate for Payer: HFN Commercial |
$1,039.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.60
|
| Rate for Payer: Quartz Beloit One Network |
$553.70
|
| Rate for Payer: Quartz Commercial |
$734.50
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$2,700.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$847.50
|
| Rate for Payer: WEA Trust Commercial |
$621.50
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
| Rate for Payer: WPS Commercial |
$836.99
|
|
|
Voiding Pressure Any Technique
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
3005558
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$1,039.60 |
| Rate for Payer: Aetna Commercial |
$1,017.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.90
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$1,039.60
|
| Rate for Payer: Health EOS Commercial |
$1,005.70
|
| Rate for Payer: HFN Commercial |
$1,039.60
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: NAPHCARE Commercial |
$678.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.60
|
| Rate for Payer: Quartz Beloit One Network |
$553.70
|
| Rate for Payer: Quartz Commercial |
$678.00
|
| Rate for Payer: WEA Trust Commercial |
$621.50
|
| Rate for Payer: WPS Commercial |
$836.99
|
|
|
Volatile and Halocarbon Intoxicants, Blood
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
6173262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: United Healthcare PPO |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Volatile and Halocarbon Intoxicants, Blood
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
6173262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.60
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: HFN Commercial |
$91.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Volatile and Halocarbon Intoxicants, Blood
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
6173262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Volatile Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Volatile Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Volatile Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Volcano Atherectomy Device
|
Facility
|
IP
|
$10,752.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
5273129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,268.48 |
| Max. Negotiated Rate |
$9,891.84 |
| Rate for Payer: Aetna Commercial |
$9,676.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,698.56
|
| Rate for Payer: Cash Price |
$3,225.60
|
| Rate for Payer: Cigna Commercial |
$9,891.84
|
| Rate for Payer: Health EOS Commercial |
$9,569.28
|
| Rate for Payer: HFN Commercial |
$9,891.84
|
| Rate for Payer: Multiplan Commercial |
$8,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,451.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,891.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,268.48
|
| Rate for Payer: Quartz Commercial |
$6,451.20
|
| Rate for Payer: WEA Trust Commercial |
$5,913.60
|
| Rate for Payer: WPS Commercial |
$7,964.01
|
|
|
Volcano Atherectomy Device
|
Facility
|
OP
|
$10,752.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
5273129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,010.56 |
| Max. Negotiated Rate |
$43,008.00 |
| Rate for Payer: Aetna Commercial |
$9,676.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,246.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,010.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,988.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,160.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,698.56
|
| Rate for Payer: Cash Price |
$3,225.60
|
| Rate for Payer: Cigna Commercial |
$9,891.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,016.82
|
| Rate for Payer: Health EOS Commercial |
$9,569.28
|
| Rate for Payer: HFN Commercial |
$9,891.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,064.00
|
| Rate for Payer: Multiplan Commercial |
$8,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,451.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,891.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,268.48
|
| Rate for Payer: Quartz Commercial |
$6,988.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,451.20
|
| Rate for Payer: The Alliance Commercial |
$43,008.00
|
| Rate for Payer: WEA Trust Commercial |
$5,913.60
|
| Rate for Payer: WPS Commercial |
$7,964.01
|
|
