|
VL Vascular Guidance Intraop
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1483402
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Aetna Commercial |
$1,857.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$977.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,173.00
|
| Rate for Payer: Health EOS Commercial |
$1,779.05
|
| Rate for Payer: HFN Commercial |
$1,857.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.50
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,857.25
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,114.35
|
| Rate for Payer: The Alliance Commercial |
$977.50
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
VL Vascular Guidance Intraop
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1483402
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$547.40 |
| Max. Negotiated Rate |
$7,820.00 |
| Rate for Payer: Aetna Commercial |
$1,759.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Aetna Managed Medicare |
$547.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,270.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$977.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$938.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.15
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.02
|
| Rate for Payer: Health EOS Commercial |
$1,739.95
|
| Rate for Payer: HFN Commercial |
$1,798.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.25
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.60
|
| Rate for Payer: Quartz Beloit One Network |
$957.95
|
| Rate for Payer: Quartz Commercial |
$1,270.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,173.00
|
| Rate for Payer: The Alliance Commercial |
$7,820.00
|
| Rate for Payer: United Healthcare PPO |
$1,466.25
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
VL Vascular Guidance Intraop
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1483402
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,798.60 |
| Rate for Payer: Aetna Commercial |
$1,759.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.15
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: Health EOS Commercial |
$1,739.95
|
| Rate for Payer: HFN Commercial |
$1,798.60
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.60
|
| Rate for Payer: Quartz Beloit One Network |
$957.95
|
| Rate for Payer: Quartz Commercial |
$1,173.00
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
VL Vasoreactivity Testing
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
1483405
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$553.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,283.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$987.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.21
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,481.25
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,283.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.00
|
| Rate for Payer: The Alliance Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare PPO |
$1,481.25
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL Vasoreactivity Testing
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
1483405
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$796.26 |
| Max. Negotiated Rate |
$1,876.25 |
| Rate for Payer: Aetna Commercial |
$1,876.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,876.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$987.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.00
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: HFN Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$796.26
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.25
|
| Rate for Payer: Quartz Beloit One Network |
$869.00
|
| Rate for Payer: Quartz Commercial |
$1,125.75
|
| Rate for Payer: The Alliance Commercial |
$987.50
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL Vasoreactivity Testing
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
1483405
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$967.75 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,185.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
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 Bilateral
|
Professional
|
Both
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.95 |
| 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: Cigna Commercial |
$2,349.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,236.50
|
| 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: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
VL Vein Mapping Bilateral
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$692.44 |
| Max. Negotiated Rate |
$9,892.00 |
| Rate for Payer: Aetna Commercial |
$2,225.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Aetna Managed Medicare |
$692.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,607.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,236.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,187.04
|
| 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: Dean Health DHI/DHP/ASO |
$1,383.89
|
| Rate for Payer: Health EOS Commercial |
$2,200.97
|
| Rate for Payer: HFN Commercial |
$2,275.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,854.75
|
| 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 |
$1,607.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,483.80
|
| Rate for Payer: The Alliance Commercial |
$9,892.00
|
| Rate for Payer: United Healthcare PPO |
$1,854.75
|
| 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 |
$344.95 |
| 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: Cigna Commercial |
$1,363.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$717.50
|
| 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: 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 |
$401.80 |
| Max. Negotiated Rate |
$5,740.00 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Aetna Managed Medicare |
$401.80
|
| 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: 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: Dean Health DHI/DHP/ASO |
$803.03
|
| 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 |
$1,076.25
|
| 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 |
$932.75
|
| Rate for Payer: Quartz Medicare Advantage |
$861.00
|
| Rate for Payer: The Alliance Commercial |
$5,740.00
|
| Rate for Payer: United Healthcare PPO |
$1,076.25
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| 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
|
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
|
|
|
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
|
|
|
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
|
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: 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 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 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: 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
|
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
|
|
