|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM AD750SC-KE25
|
Facility
|
OP
|
$2,512.00
|
|
| Hospital Charge Code |
5459712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.36 |
| Max. Negotiated Rate |
$10,048.00 |
| Rate for Payer: Aetna Commercial |
$2,260.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,160.32
|
| Rate for Payer: Aetna Managed Medicare |
$703.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,256.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,331.36
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,311.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.72
|
| Rate for Payer: Health EOS Commercial |
$2,235.68
|
| Rate for Payer: HFN Commercial |
$2,311.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$2,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,311.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.88
|
| Rate for Payer: Quartz Commercial |
$1,632.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.20
|
| Rate for Payer: The Alliance Commercial |
$10,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.60
|
| Rate for Payer: WPS Commercial |
$1,860.64
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM AD750SC-KE25
|
Facility
|
IP
|
$2,512.00
|
|
| Hospital Charge Code |
5459712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,230.88 |
| Max. Negotiated Rate |
$2,311.04 |
| Rate for Payer: Aetna Commercial |
$2,260.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,160.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,331.36
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,311.04
|
| Rate for Payer: Health EOS Commercial |
$2,235.68
|
| Rate for Payer: HFN Commercial |
$2,311.04
|
| Rate for Payer: Multiplan Commercial |
$2,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,311.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.88
|
| Rate for Payer: Quartz Commercial |
$1,507.20
|
| Rate for Payer: WEA Trust Commercial |
$1,381.60
|
| Rate for Payer: WPS Commercial |
$1,860.64
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM AD750SC-KE30
|
Facility
|
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.92 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,564.80
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM AD750SC-KE30
|
Facility
|
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.24 |
| Max. Negotiated Rate |
$10,432.00 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Aetna Managed Medicare |
$730.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,695.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,459.44
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,695.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.80
|
| Rate for Payer: The Alliance Commercial |
$10,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM AD750SC-KE35
|
Facility
|
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.92 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,564.80
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM AD750SC-KE35
|
Facility
|
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.24 |
| Max. Negotiated Rate |
$10,432.00 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Aetna Managed Medicare |
$730.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,695.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,459.44
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,695.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.80
|
| Rate for Payer: The Alliance Commercial |
$10,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM AD750SC-KE40
|
Facility
|
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.92 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,564.80
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM AD750SC-KE40
|
Facility
|
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.24 |
| Max. Negotiated Rate |
$10,432.00 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Aetna Managed Medicare |
$730.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,695.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,459.44
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,695.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.80
|
| Rate for Payer: The Alliance Commercial |
$10,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 30MM CUP 110030
|
Facility
|
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 30MM CUP 110030
|
Facility
|
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 35MM CUP 110035
|
Facility
|
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 35MM CUP 110035
|
Facility
|
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 40MM CUP 110040
|
Facility
|
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 40MM CUP 110040
|
Facility
|
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UVULECTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960484
|
|
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
|
|
|
UVULECTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960484
|
|
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
|
|
|
UVULOPALATOPHARYNOGOPLASTY/UVULECTOMY/UVULOPLASTY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960467
|
|
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
|
|
|
UVULOPALATOPHARYNOGOPLASTY/UVULECTOMY/UVULOPLASTY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960467
|
|
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
|
|
|
Vaccine/Toxoid Injection
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3040438
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Vaccine/Toxoid Injection
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3040438
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
VACURETTE 10MM CURVE 022110
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2965911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 10MM CURVE 022110
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2965911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 10MM STRAIGHT 022210
|
Facility
|
IP
|
$134.00
|
|
| Hospital Charge Code |
2965921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$80.40
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
VACURETTE 10MM STRAIGHT 022210
|
Facility
|
OP
|
$134.00
|
|
| Hospital Charge Code |
2965921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Aetna Managed Medicare |
$37.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.99
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$87.10
|
| Rate for Payer: Quartz Medicare Advantage |
$80.40
|
| Rate for Payer: The Alliance Commercial |
$536.00
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
VACURETTE 11MM CURVE 022111
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2965912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
