|
WIRE STERNAL #5
|
Facility
|
IP
|
$415.00
|
|
| Hospital Charge Code |
2965503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
WIRE STERNAL #5
|
Facility
|
OP
|
$415.00
|
|
| Hospital Charge Code |
2965503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.85 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Aetna Managed Medicare |
$120.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.53
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.70
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: NAPHCARE Commercial |
$258.96
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$280.54
|
| Rate for Payer: Quartz Medicare Advantage |
$258.96
|
| Rate for Payer: The Alliance Commercial |
$215.80
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
WIRE STERNAL #7 M655G
|
Facility
|
OP
|
$431.00
|
|
| Hospital Charge Code |
2965760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
WIRE STERNAL #7 M655G
|
Facility
|
IP
|
$431.00
|
|
| Hospital Charge Code |
2965760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
WIRE STR COUGAR XT 300CM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$414.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.72
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$888.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$888.58
|
| Rate for Payer: The Alliance Commercial |
$740.48
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
WIRE STR COUGAR XT 300CM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$888.58
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
WIRE STR THUNDER 300CM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$888.58
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
WIRE STR THUNDER 300CM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$414.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.72
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$888.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$888.58
|
| Rate for Payer: The Alliance Commercial |
$740.48
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
Wire Wholey 145cm WWFS35175
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3103302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Wire Wholey 145cm WWFS35175
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3103302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Aetna Managed Medicare |
$294.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$684.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$526.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$505.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.98
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$789.36
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: NAPHCARE Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$684.11
|
| Rate for Payer: Quartz Medicare Advantage |
$631.49
|
| Rate for Payer: The Alliance Commercial |
$526.24
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.72 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$631.49
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
Witch Hazel Pads [Med]
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
Witch Hazel Pads [Med]
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$6,968.10 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$3,184.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.90 |
| Max. Negotiated Rate |
$4,226.19 |
| Rate for Payer: Aetna Commercial |
$4,134.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.65
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,226.19
|
| Rate for Payer: Health EOS Commercial |
$4,088.38
|
| Rate for Payer: HFN Commercial |
$4,226.19
|
| Rate for Payer: Multiplan Commercial |
$3,674.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.90
|
| Rate for Payer: Quartz Commercial |
$2,756.21
|
| Rate for Payer: WEA Trust Commercial |
$2,526.52
|
| Rate for Payer: WPS Commercial |
$3,402.42
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$6,968.10 |
| Rate for Payer: Aetna Commercial |
$4,134.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,226.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$4,088.38
|
| Rate for Payer: HFN Commercial |
$4,226.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$3,674.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.90
|
| Rate for Payer: Quartz Commercial |
$2,985.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$3,184.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$2,526.52
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$3,402.42
|
|
|
WITH CATH PLCMT IN BYPASS GRAFT INC INTRA INJ 9345526
|
Professional
|
Both
|
$5,825.00
|
|
|
Service Code
|
CPT 93455 26
|
| Hospital Charge Code |
3015391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.08 |
| Max. Negotiated Rate |
$5,755.10 |
| Rate for Payer: Aetna Commercial |
$5,755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,209.88
|
| Rate for Payer: Aetna Managed Medicare |
$255.15
|
| Rate for Payer: Anthem Medicare Advantage |
$255.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$255.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$255.15
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cigna Commercial |
$5,755.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.15
|
| Rate for Payer: Health EOS Commercial |
$5,512.78
|
| Rate for Payer: HFN Commercial |
$5,755.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$937.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$255.15
|
| Rate for Payer: Multiplan Commercial |
$4,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$382.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,755.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,665.52
|
| Rate for Payer: Quartz Commercial |
$3,453.06
|
| Rate for Payer: Quartz Medicare Advantage |
$255.15
|
| Rate for Payer: The Alliance Commercial |
$969.58
|
| Rate for Payer: United Healthcare Medicaid |
$216.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.15
|
| Rate for Payer: WEA Trust Commercial |
$3,331.90
|
| Rate for Payer: WPS Commercial |
$1,020.61
|
|
|
With Transl Stent Placement (S), Inc Angio 3722122
|
Professional
|
Both
|
$17,376.00
|
|
|
Service Code
|
CPT 37221 22
|
| Hospital Charge Code |
5078631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$17,167.49 |
| Rate for Payer: Aetna Commercial |
$17,167.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.09
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cigna Commercial |
$17,167.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,035.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,842.62
|
| Rate for Payer: Health EOS Commercial |
$16,444.65
|
| Rate for Payer: HFN Commercial |
$17,167.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$14,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$17,167.49
|
| Rate for Payer: Quartz Beloit One Network |
$7,951.26
|
| Rate for Payer: Quartz Commercial |
$10,300.49
|
| Rate for Payer: The Alliance Commercial |
$9,035.52
|
| Rate for Payer: WEA Trust Commercial |
$9,939.07
|
| Rate for Payer: WPS Commercial |
$13,384.73
|
|
|
With Transl Stent Placement(S), Inc Angio 3722150
|
Professional
|
Both
|
$28,960.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
3462168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$28,612.48 |
| Rate for Payer: Aetna Commercial |
$28,612.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,901.82
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cigna Commercial |
$28,612.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,059.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,071.04
|
| Rate for Payer: Health EOS Commercial |
$27,407.74
|
| Rate for Payer: HFN Commercial |
$28,612.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$24,094.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28,612.48
|
| Rate for Payer: Quartz Beloit One Network |
$13,252.10
|
| Rate for Payer: Quartz Commercial |
$17,167.49
|
| Rate for Payer: The Alliance Commercial |
$15,059.20
|
| Rate for Payer: WEA Trust Commercial |
$16,565.12
|
| Rate for Payer: WPS Commercial |
$22,307.89
|
|
|
With Transl Stent Placement (S), Inc Angio, Extnd Svc & Bilateral 372212250
|
Professional
|
Both
|
$34,753.00
|
|
|
Service Code
|
CPT 37221 22,50
|
| Hospital Charge Code |
6173582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$34,335.96 |
| Rate for Payer: Aetna Commercial |
$34,335.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,083.08
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cigna Commercial |
$34,335.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,071.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,685.87
|
| Rate for Payer: Health EOS Commercial |
$32,890.24
|
| Rate for Payer: HFN Commercial |
$34,335.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$28,914.50
|
| Rate for Payer: Preferred Network Access Commercial |
$34,335.96
|
| Rate for Payer: Quartz Beloit One Network |
$15,902.97
|
| Rate for Payer: Quartz Commercial |
$20,601.58
|
| Rate for Payer: The Alliance Commercial |
$18,071.56
|
| Rate for Payer: WEA Trust Commercial |
$19,878.72
|
| Rate for Payer: WPS Commercial |
$26,770.24
|
|
|
WITH TRANSL STENT PLACEMENT(S), INC ANGIO SAME VES 37221
|
Professional
|
Both
|
$14,479.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3014551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$14,305.25 |
| Rate for Payer: Aetna Commercial |
$14,305.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,950.02
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cigna Commercial |
$14,305.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,529.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,034.90
|
| Rate for Payer: Health EOS Commercial |
$13,702.93
|
| Rate for Payer: HFN Commercial |
$14,305.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$12,046.53
|
| Rate for Payer: Preferred Network Access Commercial |
$14,305.25
|
| Rate for Payer: Quartz Beloit One Network |
$6,625.59
|
| Rate for Payer: Quartz Commercial |
$8,583.15
|
| Rate for Payer: The Alliance Commercial |
$7,529.08
|
| Rate for Payer: WEA Trust Commercial |
$8,281.99
|
| Rate for Payer: WPS Commercial |
$11,153.17
|
|
|
WND PREP CH/INF, F/N/HF/G 15004
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
3013632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.48 |
| Max. Negotiated Rate |
$992.16 |
| Rate for Payer: Aetna Commercial |
$689.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$220.48
|
| Rate for Payer: Anthem Medicare Advantage |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$220.48
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$689.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.48
|
| Rate for Payer: Health EOS Commercial |
$660.59
|
| Rate for Payer: HFN Commercial |
$689.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$220.48
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$330.72
|
| Rate for Payer: Preferred Network Access Commercial |
$689.62
|
| Rate for Payer: Quartz Beloit One Network |
$319.40
|
| Rate for Payer: Quartz Commercial |
$413.77
|
| Rate for Payer: Quartz Medicare Advantage |
$220.48
|
| Rate for Payer: The Alliance Commercial |
$937.04
|
| Rate for Payer: United Healthcare Medicaid |
$303.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.48
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$992.16
|
|
|
WND PREP F/N/HF/G ADDL CM 15005
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
5587501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.47 |
| Max. Negotiated Rate |
$326.10 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$72.47
|
| Rate for Payer: Anthem Medicare Advantage |
$72.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.47
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$254.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.47
|
| Rate for Payer: Health EOS Commercial |
$244.17
|
| Rate for Payer: HFN Commercial |
$254.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.47
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$108.70
|
| Rate for Payer: Preferred Network Access Commercial |
$254.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.06
|
| Rate for Payer: Quartz Commercial |
$152.94
|
| Rate for Payer: Quartz Medicare Advantage |
$72.47
|
| Rate for Payer: The Alliance Commercial |
$307.99
|
| Rate for Payer: United Healthcare Medicaid |
$94.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.47
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$326.10
|
|
