|
Ablate Inf Turbinate, Superf 3080150
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 30801 50
|
| Hospital Charge Code |
3921395
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$536.66 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$396.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.22
|
| Rate for Payer: Health EOS Commercial |
$379.51
|
| Rate for Payer: HFN Commercial |
$396.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.66
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: Preferred Network Access Commercial |
$396.19
|
| Rate for Payer: Quartz Beloit One Network |
$183.50
|
| Rate for Payer: Quartz Commercial |
$237.71
|
| Rate for Payer: The Alliance Commercial |
$208.52
|
| Rate for Payer: United Healthcare Medicaid |
$104.54
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
ABLATION, RENAL TUMOR(S), UNILATERAL, PERCUTANEOUS, CRYOTHERAPY
|
Facility
|
OP
|
$44,746.87
|
|
|
Service Code
|
CPT 50593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$44,746.87 |
| Rate for Payer: Aetna Managed Medicare |
$11,186.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,186.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,186.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,186.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,614.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,186.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,186.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,186.72
|
| Rate for Payer: NAPHCARE Commercial |
$16,780.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11,186.72
|
| Rate for Payer: The Alliance Commercial |
$44,746.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,186.72
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$11,186.72
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$6,531.49
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,632.87 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| 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 |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
|
OP
|
$6,531.49
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,632.87 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| 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 |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
|
|
ABLATOR 4MM 90DEG ASPIR AR-9803A-90
|
Facility
|
OP
|
$2,877.00
|
|
| Hospital Charge Code |
2964710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.78 |
| Max. Negotiated Rate |
$2,752.71 |
| Rate for Payer: Aetna Commercial |
$2,692.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.19
|
| Rate for Payer: Aetna Managed Medicare |
$837.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.80
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,752.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,674.41
|
| Rate for Payer: Health EOS Commercial |
$2,662.95
|
| Rate for Payer: HFN Commercial |
$2,752.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,244.06
|
| Rate for Payer: Multiplan Commercial |
$2,393.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.12
|
| Rate for Payer: Quartz Commercial |
$1,944.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,795.25
|
| Rate for Payer: The Alliance Commercial |
$1,496.04
|
| Rate for Payer: WEA Trust Commercial |
$1,645.64
|
| Rate for Payer: WPS Commercial |
$2,216.15
|
|
|
ABLATOR 4MM 90DEG ASPIR AR-9803A-90
|
Facility
|
IP
|
$2,877.00
|
|
| Hospital Charge Code |
2964710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,466.12 |
| Max. Negotiated Rate |
$2,752.71 |
| Rate for Payer: Aetna Commercial |
$2,692.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.80
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,752.71
|
| Rate for Payer: Health EOS Commercial |
$2,662.95
|
| Rate for Payer: HFN Commercial |
$2,752.71
|
| Rate for Payer: Multiplan Commercial |
$2,393.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.12
|
| Rate for Payer: Quartz Commercial |
$1,795.25
|
| Rate for Payer: WEA Trust Commercial |
$1,645.64
|
| Rate for Payer: WPS Commercial |
$2,216.15
|
|
|
ABLATOR APOLLO ASPIRATING ARTHREX AR-9821
|
Facility
|
IP
|
$2,896.00
|
|
| Hospital Charge Code |
5206680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,475.80 |
| Max. Negotiated Rate |
$2,770.89 |
| Rate for Payer: Aetna Commercial |
$2,710.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,590.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,596.28
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$2,770.89
|
| Rate for Payer: Health EOS Commercial |
$2,680.54
|
| Rate for Payer: HFN Commercial |
$2,770.89
|
| Rate for Payer: Multiplan Commercial |
$2,409.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.80
|
| Rate for Payer: Quartz Commercial |
$1,807.10
|
| Rate for Payer: WEA Trust Commercial |
$1,656.51
|
| Rate for Payer: WPS Commercial |
$2,230.79
|
|
|
ABLATOR APOLLO ASPIRATING ARTHREX AR-9821
|
Facility
|
OP
|
$2,896.00
|
|
| Hospital Charge Code |
5206680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.32 |
| Max. Negotiated Rate |
$2,770.89 |
| Rate for Payer: Aetna Commercial |
$2,710.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,590.18
|
| Rate for Payer: Aetna Managed Medicare |
$843.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,957.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,505.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,445.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,596.28
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$2,770.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,685.47
|
| Rate for Payer: Health EOS Commercial |
$2,680.54
|
| Rate for Payer: HFN Commercial |
$2,770.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,258.88
|
| Rate for Payer: Multiplan Commercial |
$2,409.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,807.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.80
|
| Rate for Payer: Quartz Commercial |
$1,957.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,807.10
|
| Rate for Payer: The Alliance Commercial |
$1,505.92
|
| Rate for Payer: WEA Trust Commercial |
$1,656.51
|
| Rate for Payer: WPS Commercial |
$2,230.79
|
|
|
ABLATOR APOLLO I90 ASPIRATING ARTHREX AR-9831
|
Facility
|
OP
|
$2,221.00
|
|
| Hospital Charge Code |
6234163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.76 |
| Max. Negotiated Rate |
$2,125.05 |
| Rate for Payer: Aetna Commercial |
$2,078.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,986.46
|
| Rate for Payer: Aetna Managed Medicare |
$646.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,501.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,154.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,108.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,224.22
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cigna Commercial |
$2,125.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,292.62
|
| Rate for Payer: Health EOS Commercial |
$2,055.76
|
| Rate for Payer: HFN Commercial |
$2,125.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,732.38
|
| Rate for Payer: Multiplan Commercial |
$1,847.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,385.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,125.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,131.82
|
| Rate for Payer: Quartz Commercial |
$1,501.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,385.90
|
| Rate for Payer: The Alliance Commercial |
$1,154.92
|
| Rate for Payer: WEA Trust Commercial |
$1,270.41
|
| Rate for Payer: WPS Commercial |
$1,710.84
|
|
|
ABLATOR APOLLO I90 ASPIRATING ARTHREX AR-9831
|
Facility
|
IP
|
$2,221.00
|
|
| Hospital Charge Code |
6234163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,131.82 |
| Max. Negotiated Rate |
$2,125.05 |
| Rate for Payer: Aetna Commercial |
$2,078.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,986.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,224.22
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cigna Commercial |
$2,125.05
|
| Rate for Payer: Health EOS Commercial |
$2,055.76
|
| Rate for Payer: HFN Commercial |
$2,125.05
|
| Rate for Payer: Multiplan Commercial |
$1,847.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,125.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,131.82
|
| Rate for Payer: Quartz Commercial |
$1,385.90
|
| Rate for Payer: WEA Trust Commercial |
$1,270.41
|
| Rate for Payer: WPS Commercial |
$1,710.84
|
|
|
ABLATOR APOLLO RF ASPIRATING 50DEG MULTI-PORT AR-9815
|
Facility
|
IP
|
$2,432.00
|
|
| Hospital Charge Code |
5414730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,239.35 |
| Max. Negotiated Rate |
$2,326.94 |
| Rate for Payer: Aetna Commercial |
$2,276.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,175.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,340.52
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$2,326.94
|
| Rate for Payer: Health EOS Commercial |
$2,251.06
|
| Rate for Payer: HFN Commercial |
$2,326.94
|
| Rate for Payer: Multiplan Commercial |
$2,023.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,326.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,239.35
|
| Rate for Payer: Quartz Commercial |
$1,517.57
|
| Rate for Payer: WEA Trust Commercial |
$1,391.10
|
| Rate for Payer: WPS Commercial |
$1,873.37
|
|
|
ABLATOR APOLLO RF ASPIRATING 50DEG MULTI-PORT AR-9815
|
Facility
|
OP
|
$2,432.00
|
|
| Hospital Charge Code |
5414730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.20 |
| Max. Negotiated Rate |
$2,326.94 |
| Rate for Payer: Aetna Commercial |
$2,276.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,175.18
|
| Rate for Payer: Aetna Managed Medicare |
$708.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,644.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,264.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,214.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,340.52
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$2,326.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,415.42
|
| Rate for Payer: Health EOS Commercial |
$2,251.06
|
| Rate for Payer: HFN Commercial |
$2,326.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,896.96
|
| Rate for Payer: Multiplan Commercial |
$2,023.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,326.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,239.35
|
| Rate for Payer: Quartz Commercial |
$1,644.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,517.57
|
| Rate for Payer: The Alliance Commercial |
$1,264.64
|
| Rate for Payer: WEA Trust Commercial |
$1,391.10
|
| Rate for Payer: WPS Commercial |
$1,873.37
|
|
|
ABLATOR APOLLO RF ASPIRATING 90DEG MULTI-PORT AR-9811
|
Facility
|
OP
|
$3,010.00
|
|
| Hospital Charge Code |
5074888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$876.51 |
| Max. Negotiated Rate |
$2,879.97 |
| Rate for Payer: Aetna Commercial |
$2,817.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,692.14
|
| Rate for Payer: Aetna Managed Medicare |
$876.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,034.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,565.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,502.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.11
|
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cigna Commercial |
$2,879.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,751.82
|
| Rate for Payer: Health EOS Commercial |
$2,786.06
|
| Rate for Payer: HFN Commercial |
$2,879.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,347.80
|
| Rate for Payer: Multiplan Commercial |
$2,504.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,878.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,879.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,533.90
|
| Rate for Payer: Quartz Commercial |
$2,034.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,878.24
|
| Rate for Payer: The Alliance Commercial |
$1,565.20
|
| Rate for Payer: WEA Trust Commercial |
$1,721.72
|
| Rate for Payer: WPS Commercial |
$2,318.60
|
|
|
ABLATOR APOLLO RF ASPIRATING 90DEG MULTI-PORT AR-9811
|
Facility
|
IP
|
$3,010.00
|
|
| Hospital Charge Code |
5074888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,533.90 |
| Max. Negotiated Rate |
$2,879.97 |
| Rate for Payer: Aetna Commercial |
$2,817.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,692.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.11
|
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cigna Commercial |
$2,879.97
|
| Rate for Payer: Health EOS Commercial |
$2,786.06
|
| Rate for Payer: HFN Commercial |
$2,879.97
|
| Rate for Payer: Multiplan Commercial |
$2,504.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,879.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,533.90
|
| Rate for Payer: Quartz Commercial |
$1,878.24
|
| Rate for Payer: WEA Trust Commercial |
$1,721.72
|
| Rate for Payer: WPS Commercial |
$2,318.60
|
|
|
ABLATOR APOLLO RF J50 ASPIRATING 50DEG AR-9845
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
5831630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.05 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,595.57
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
ABLATOR APOLLO RF J50 ASPIRATING 50DEG AR-9845
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
5831630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Aetna Managed Medicare |
$744.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.17
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.46
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,728.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.57
|
| Rate for Payer: The Alliance Commercial |
$1,329.64
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
ABLATOR APOLLO RF NON-ASPIRATING HOOK AR-9825
|
Facility
|
OP
|
$2,368.00
|
|
| Hospital Charge Code |
5804228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.56 |
| Max. Negotiated Rate |
$2,265.70 |
| Rate for Payer: Aetna Commercial |
$2,216.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.94
|
| Rate for Payer: Aetna Managed Medicare |
$689.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,600.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,231.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,182.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.24
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,265.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,378.18
|
| Rate for Payer: Health EOS Commercial |
$2,191.82
|
| Rate for Payer: HFN Commercial |
$2,265.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,847.04
|
| Rate for Payer: Multiplan Commercial |
$1,970.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,477.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.73
|
| Rate for Payer: Quartz Commercial |
$1,600.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,477.63
|
| Rate for Payer: The Alliance Commercial |
$1,231.36
|
| Rate for Payer: WEA Trust Commercial |
$1,354.50
|
| Rate for Payer: WPS Commercial |
$1,824.07
|
|
|
ABLATOR APOLLO RF NON-ASPIRATING HOOK AR-9825
|
Facility
|
IP
|
$2,368.00
|
|
| Hospital Charge Code |
5804228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,206.73 |
| Max. Negotiated Rate |
$2,265.70 |
| Rate for Payer: Aetna Commercial |
$2,216.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.24
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,265.70
|
| Rate for Payer: Health EOS Commercial |
$2,191.82
|
| Rate for Payer: HFN Commercial |
$2,265.70
|
| Rate for Payer: Multiplan Commercial |
$1,970.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.73
|
| Rate for Payer: Quartz Commercial |
$1,477.63
|
| Rate for Payer: WEA Trust Commercial |
$1,354.50
|
| Rate for Payer: WPS Commercial |
$1,824.07
|
|
|
ABO/Rh Cord
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$492.41 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.98
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$4.66
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$73.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$12.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: United Healthcare PPO |
$84.24
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: Wellcare Medicare |
$3.11
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
ABO/Rh Cord
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$67.39
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
ABO/Rh Heel
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3154817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$492.41 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.98
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$4.66
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$73.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$12.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: United Healthcare PPO |
$84.24
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: Wellcare Medicare |
$3.11
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
ABO/Rh Heel
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3154817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$67.39
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES
|
Facility
|
OP
|
$543.77
|
|
|
Service Code
|
EAPG 00194
|
| Min. Negotiated Rate |
$522.86 |
| Max. Negotiated Rate |
$543.77 |
| Rate for Payer: Anthem Medicaid |
$522.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$522.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$522.86
|
| Rate for Payer: Dean Health Medicaid |
$522.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$522.86
|
| Rate for Payer: Managed Health Services Medicaid |
$543.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$522.86
|
| Rate for Payer: United Healthcare Medicaid |
$522.86
|
|
|
ABORTION RELATED DIAGNOSES
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00763
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Anthem Medicaid |
$93.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$93.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.23
|
| Rate for Payer: Dean Health Medicaid |
$93.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$93.23
|
| Rate for Payer: Managed Health Services Medicaid |
$96.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$93.23
|
| Rate for Payer: United Healthcare Medicaid |
$93.23
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$22,417.20
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$8,185.66 |
| Max. Negotiated Rate |
$22,417.20 |
| Rate for Payer: Aetna Managed Medicare |
$8,185.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,878.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,769.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,932.02
|
| Rate for Payer: Anthem Medicare Advantage |
$8,185.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,185.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,185.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,185.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,686.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,185.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,197.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,185.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,185.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,185.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,185.66
|
| Rate for Payer: NAPHCARE Commercial |
$12,278.49
|
| Rate for Payer: Quartz Medicare Advantage |
$8,185.66
|
| Rate for Payer: The Alliance Commercial |
$22,417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,185.66
|
| Rate for Payer: United Healthcare PPO |
$12,610.06
|
| Rate for Payer: Wellcare Medicare |
$8,185.66
|
|
