|
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: 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
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 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: 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 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: 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 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 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: 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 |
$13,286.32 |
| 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 |
$13,286.32
|
| 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: 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
|
Professional
|
$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: 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: 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 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 |
$88.32 |
| 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: 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: 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: United Healthcare PPO |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Volatile Screen
|
Professional
|
$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: 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: 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: 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 |
$9,891.84 |
| 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: WEA Trust Commercial |
$5,913.60
|
| Rate for Payer: WPS Commercial |
$7,964.01
|
|
|
von Hippel-Lindau Sequencing
|
Professional
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.83 |
| Max. Negotiated Rate |
$1,209.25 |
| Rate for Payer: Aetna Commercial |
$957.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Aetna Managed Medicare |
$274.83
|
| Rate for Payer: Anthem Medicare Advantage |
$274.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$274.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$274.83
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$957.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.83
|
| Rate for Payer: Health EOS Commercial |
$917.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$274.83
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$957.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.52
|
| Rate for Payer: Quartz Commercial |
$574.56
|
| Rate for Payer: Quartz Medicare Advantage |
$274.83
|
| Rate for Payer: The Alliance Commercial |
$1,085.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.83
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$1,209.25
|
|
|
von Hippel-Lindau Sequencing
|
Facility
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.83 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Aetna Managed Medicare |
$274.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$480.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.22
|
| Rate for Payer: Anthem Medicaid |
$274.83
|
| Rate for Payer: Anthem Medicare Advantage |
$274.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$274.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$274.83
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$274.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.83
|
| Rate for Payer: Dean Health Medicaid |
$274.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$274.83
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,022.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$274.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$274.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$274.83
|
| Rate for Payer: Managed Health Services Medicaid |
$285.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$274.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$274.83
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$412.24
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$274.83
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$655.20
|
| Rate for Payer: Quartz Medicare Advantage |
$274.83
|
| Rate for Payer: The Alliance Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare Medicaid |
$274.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.83
|
| Rate for Payer: United Healthcare PPO |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: Wellcare Medicare |
$274.83
|
| Rate for Payer: WMAP Medicaid |
$274.83
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
von Hippel-Lindau Sequencing
|
Facility
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$493.92 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$604.80
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$604.80
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
von Willebrand Comprehensive Panel
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
von Willebrand Comprehensive Panel
|
Professional
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$26.44
|
|
|
von Willebrand Comprehensive Panel
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicaid |
$6.21
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.21
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$608.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WMAP Medicaid |
$6.21
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
