|
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 |
$90.17 |
| Max. Negotiated Rate |
$1,417.78 |
| Rate for Payer: Aetna Commercial |
$1,417.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.46
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,417.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,358.08
|
| Rate for Payer: HFN Commercial |
$1,417.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,193.92
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.78
|
| Rate for Payer: Quartz Beloit One Network |
$656.66
|
| Rate for Payer: Quartz Commercial |
$850.67
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$820.82
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
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 |
$731.28 |
| Max. Negotiated Rate |
$1,373.01 |
| Rate for Payer: Aetna Commercial |
$1,343.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$790.97
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,373.01
|
| Rate for Payer: Health EOS Commercial |
$1,328.24
|
| Rate for Payer: HFN Commercial |
$1,373.01
|
| Rate for Payer: Multiplan Commercial |
$1,193.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.01
|
| Rate for Payer: Quartz Beloit One Network |
$731.28
|
| Rate for Payer: Quartz Commercial |
$895.44
|
| Rate for Payer: WEA Trust Commercial |
$820.82
|
| Rate for Payer: WPS Commercial |
$1,105.38
|
|
|
VOCAL CORD STRIPPING
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
VOCAL CORD STRIPPING
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 10mm #BE 6010
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 10mm #BE 6010
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.44 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$326.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.38
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$699.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: Quartz Medicare Advantage |
$699.50
|
| Rate for Payer: The Alliance Commercial |
$582.92
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 12mm #LP16-012
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.44 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$326.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.38
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$699.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: Quartz Medicare Advantage |
$699.50
|
| Rate for Payer: The Alliance Commercial |
$582.92
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 12mm #LP16-012
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 14mm #BE 6011
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS Low Pressure 16fr 14mm #BE 6011
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.44 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$326.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.38
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$699.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: Quartz Medicare Advantage |
$699.50
|
| Rate for Payer: The Alliance Commercial |
$582.92
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 8mm #LP16-008
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
2972049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.44 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$326.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.38
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$699.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: Quartz Medicare Advantage |
$699.50
|
| Rate for Payer: The Alliance Commercial |
$582.92
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
VOICE PROSTHESIS LOW PRESSURE 16FR 8mm #LP16-008
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
2972049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
Voiding Pressure Any Technique
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
3005558
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$564.10 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,057.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,010.67
|
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$763.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$587.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$564.10
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$733.82
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$1,081.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$733.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$733.82
|
| Rate for Payer: Health EOS Commercial |
$1,045.93
|
| Rate for Payer: HFN Commercial |
$1,081.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$733.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$733.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$733.82
|
| Rate for Payer: Multiplan Commercial |
$940.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,081.18
|
| Rate for Payer: Quartz Beloit One Network |
$575.85
|
| Rate for Payer: Quartz Commercial |
$763.88
|
| Rate for Payer: Quartz Medicare Advantage |
$733.82
|
| Rate for Payer: The Alliance Commercial |
$2,935.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$733.82
|
| Rate for Payer: United Healthcare PPO |
$881.40
|
| Rate for Payer: WEA Trust Commercial |
$646.36
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
| Rate for Payer: WPS Commercial |
$870.44
|
|
|
Voiding Pressure Any Technique
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
3005558
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$575.85 |
| Max. Negotiated Rate |
$1,081.18 |
| Rate for Payer: Aetna Commercial |
$1,057.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,010.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.86
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$1,081.18
|
| Rate for Payer: Health EOS Commercial |
$1,045.93
|
| Rate for Payer: HFN Commercial |
$1,081.18
|
| Rate for Payer: Multiplan Commercial |
$940.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,081.18
|
| Rate for Payer: Quartz Beloit One Network |
$575.85
|
| Rate for Payer: Quartz Commercial |
$705.12
|
| Rate for Payer: WEA Trust Commercial |
$646.36
|
| Rate for Payer: WPS Commercial |
$870.44
|
|
|
Volatile and Halocarbon Intoxicants, Blood
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
6173262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.93 |
| Max. Negotiated Rate |
$94.85 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.90
|
| Rate for Payer: Health EOS Commercial |
$90.85
|
| Rate for Payer: HFN Commercial |
$94.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$94.85
|
| Rate for Payer: Quartz Beloit One Network |
$43.93
|
| Rate for Payer: Quartz Commercial |
$56.91
|
| Rate for Payer: The Alliance Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Volatile and Halocarbon Intoxicants, Blood
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
6173262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$27.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.87
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: Quartz Medicare Advantage |
$59.90
|
| Rate for Payer: The Alliance Commercial |
$49.92
|
| Rate for Payer: United Healthcare PPO |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Volatile and Halocarbon Intoxicants, Blood
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
6173262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Volatile Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Volatile Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Volatile Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.95
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Volcano Atherectomy Device
|
Facility
|
IP
|
$10,752.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
5273129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,479.22 |
| Max. Negotiated Rate |
$10,287.51 |
| Rate for Payer: Aetna Commercial |
$10,063.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,616.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,926.50
|
| Rate for Payer: Cash Price |
$3,225.60
|
| Rate for Payer: Cigna Commercial |
$10,287.51
|
| Rate for Payer: Health EOS Commercial |
$9,952.05
|
| Rate for Payer: HFN Commercial |
$10,287.51
|
| Rate for Payer: Multiplan Commercial |
$8,945.66
|
| Rate for Payer: Preferred Network Access Commercial |
$10,287.51
|
| Rate for Payer: Quartz Beloit One Network |
$5,479.22
|
| Rate for Payer: Quartz Commercial |
$6,709.25
|
| Rate for Payer: WEA Trust Commercial |
$6,150.14
|
| Rate for Payer: WPS Commercial |
$8,282.27
|
|
|
Volcano Atherectomy Device
|
Facility
|
OP
|
$10,752.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
5273129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,130.98 |
| Max. Negotiated Rate |
$10,287.51 |
| Rate for Payer: Aetna Commercial |
$10,063.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,616.59
|
| Rate for Payer: Aetna Managed Medicare |
$3,130.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,268.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,591.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,367.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,926.50
|
| Rate for Payer: Cash Price |
$3,225.60
|
| Rate for Payer: Cigna Commercial |
$10,287.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,257.66
|
| Rate for Payer: Health EOS Commercial |
$9,952.05
|
| Rate for Payer: HFN Commercial |
$10,287.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,386.56
|
| Rate for Payer: Multiplan Commercial |
$8,945.66
|
| Rate for Payer: NAPHCARE Commercial |
$6,709.25
|
| Rate for Payer: Preferred Network Access Commercial |
$10,287.51
|
| Rate for Payer: Quartz Beloit One Network |
$5,479.22
|
| Rate for Payer: Quartz Commercial |
$7,268.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6,709.25
|
| Rate for Payer: The Alliance Commercial |
$5,591.04
|
| Rate for Payer: WEA Trust Commercial |
$6,150.14
|
| Rate for Payer: WPS Commercial |
$8,282.27
|
|
|
von Hippel-Lindau Sequencing
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$964.45 |
| Rate for Payer: Aetna Commercial |
$943.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.61
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$964.45
|
| Rate for Payer: Health EOS Commercial |
$933.00
|
| Rate for Payer: HFN Commercial |
$964.45
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: Preferred Network Access Commercial |
$964.45
|
| Rate for Payer: Quartz Beloit One Network |
$513.68
|
| Rate for Payer: Quartz Commercial |
$628.99
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: WPS Commercial |
$776.46
|
|
|
von Hippel-Lindau Sequencing
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.82 |
| Max. Negotiated Rate |
$1,143.29 |
| Rate for Payer: Aetna Commercial |
$943.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Aetna Managed Medicare |
$285.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,071.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.47
|
| Rate for Payer: Anthem Medicare Advantage |
$285.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$285.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$285.82
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$964.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$285.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$285.82
|
| Rate for Payer: Health EOS Commercial |
$933.00
|
| Rate for Payer: HFN Commercial |
$964.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,063.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$285.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$285.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: NAPHCARE Commercial |
$428.73
|
| Rate for Payer: Preferred Network Access Commercial |
$964.45
|
| Rate for Payer: Quartz Beloit One Network |
$513.68
|
| Rate for Payer: Quartz Commercial |
$681.41
|
| Rate for Payer: Quartz Medicare Advantage |
$285.82
|
| Rate for Payer: The Alliance Commercial |
$1,143.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.82
|
| Rate for Payer: United Healthcare PPO |
$786.24
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: Wellcare Medicare |
$285.82
|
| Rate for Payer: WPS Commercial |
$776.46
|
|
|
von Hippel-Lindau Sequencing
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.82 |
| Max. Negotiated Rate |
$1,257.62 |
| Rate for Payer: Aetna Commercial |
$995.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Aetna Managed Medicare |
$285.82
|
| Rate for Payer: Anthem Medicare Advantage |
$285.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$285.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$285.82
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$995.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$524.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.82
|
| Rate for Payer: Health EOS Commercial |
$953.97
|
| Rate for Payer: HFN Commercial |
$995.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: NAPHCARE Commercial |
$428.73
|
| Rate for Payer: Preferred Network Access Commercial |
$995.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.26
|
| Rate for Payer: Quartz Commercial |
$597.54
|
| Rate for Payer: Quartz Medicare Advantage |
$285.82
|
| Rate for Payer: The Alliance Commercial |
$1,129.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.82
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: WPS Commercial |
$1,257.62
|
|
