|
Bladder Irrigation, lavage 51700
|
Professional
|
$420.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
1188984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Aetna Managed Medicare |
$27.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.94
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.94
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: Quartz Medicare Advantage |
$27.94
|
| Rate for Payer: The Alliance Commercial |
$118.74
|
| Rate for Payer: United Healthcare Medicaid |
$18.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$125.73
|
|
|
BLADDER SLING ADVANTAGE FIT MID-URETHRA 850-2110 M0068502110
|
Facility
OP
|
$7,638.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3838943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,138.64 |
| Max. Negotiated Rate |
$7,026.96 |
| Rate for Payer: Aetna Commercial |
$6,874.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,568.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,138.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,964.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,666.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,048.14
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cigna Commercial |
$7,026.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,274.22
|
| Rate for Payer: Health EOS Commercial |
$6,797.82
|
| Rate for Payer: HFN Commercial |
$7,026.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,728.50
|
| Rate for Payer: Multiplan Commercial |
$6,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,582.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,026.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,742.62
|
| Rate for Payer: Quartz Commercial |
$4,964.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,582.80
|
| Rate for Payer: WEA Trust Commercial |
$4,200.90
|
| Rate for Payer: WPS Commercial |
$5,657.47
|
|
|
BLADDER SLING ADVANTAGE FIT MID-URETHRA 850-2110 M0068502110
|
Facility
IP
|
$7,638.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3838943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,742.62 |
| Max. Negotiated Rate |
$7,026.96 |
| Rate for Payer: Aetna Commercial |
$6,874.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,048.14
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cigna Commercial |
$7,026.96
|
| Rate for Payer: Health EOS Commercial |
$6,797.82
|
| Rate for Payer: HFN Commercial |
$7,026.96
|
| Rate for Payer: Multiplan Commercial |
$6,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,582.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,026.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,742.62
|
| Rate for Payer: Quartz Commercial |
$4,582.80
|
| Rate for Payer: WEA Trust Commercial |
$4,200.90
|
| Rate for Payer: WPS Commercial |
$5,657.47
|
|
|
BLADDER SLING ADVANTAGE MID-URETHRA 850-200 M0068502000
|
Facility
OP
|
$7,355.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
4519463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,059.40 |
| Max. Negotiated Rate |
$6,766.60 |
| Rate for Payer: Aetna Commercial |
$6,619.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,325.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,059.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,780.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,677.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,530.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,898.15
|
| Rate for Payer: Cash Price |
$2,206.50
|
| Rate for Payer: Cigna Commercial |
$6,766.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,115.86
|
| Rate for Payer: Health EOS Commercial |
$6,545.95
|
| Rate for Payer: HFN Commercial |
$6,766.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,516.25
|
| Rate for Payer: Multiplan Commercial |
$5,884.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,413.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,766.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,603.95
|
| Rate for Payer: Quartz Commercial |
$4,780.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,413.00
|
| Rate for Payer: WEA Trust Commercial |
$4,045.25
|
| Rate for Payer: WPS Commercial |
$5,447.85
|
|
|
BLADDER SLING ADVANTAGE MID-URETHRA 850-200 M0068502000
|
Facility
IP
|
$7,355.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
4519463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,603.95 |
| Max. Negotiated Rate |
$6,766.60 |
| Rate for Payer: Aetna Commercial |
$6,619.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,898.15
|
| Rate for Payer: Cash Price |
$2,206.50
|
| Rate for Payer: Cigna Commercial |
$6,766.60
|
| Rate for Payer: Health EOS Commercial |
$6,545.95
|
| Rate for Payer: HFN Commercial |
$6,766.60
|
| Rate for Payer: Multiplan Commercial |
$5,884.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,413.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,766.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,603.95
|
| Rate for Payer: Quartz Commercial |
$4,413.00
|
| Rate for Payer: WEA Trust Commercial |
$4,045.25
|
| Rate for Payer: WPS Commercial |
$5,447.85
|
|
|
BLADDER SLING LYNX MIDURETHRAL 850-300
|
Facility
OP
|
$6,618.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2964826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,853.04 |
| Max. Negotiated Rate |
$6,088.56 |
| Rate for Payer: Aetna Commercial |
$5,956.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,691.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,853.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,301.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,309.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,176.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,507.54
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$6,088.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,703.43
|
| Rate for Payer: Health EOS Commercial |
$5,890.02
|
| Rate for Payer: HFN Commercial |
$6,088.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,963.50
|
| Rate for Payer: Multiplan Commercial |
$5,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,970.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,088.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,242.82
|
| Rate for Payer: Quartz Commercial |
$4,301.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,970.80
|
| Rate for Payer: WEA Trust Commercial |
$3,639.90
|
| Rate for Payer: WPS Commercial |
$4,901.95
|
|
|
BLADDER SLING LYNX MIDURETHRAL 850-300
|
Facility
IP
|
$6,618.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2964826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,242.82 |
| Max. Negotiated Rate |
$6,088.56 |
| Rate for Payer: Aetna Commercial |
$5,956.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,507.54
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$6,088.56
|
| Rate for Payer: Health EOS Commercial |
$5,890.02
|
| Rate for Payer: HFN Commercial |
$6,088.56
|
| Rate for Payer: Multiplan Commercial |
$5,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,970.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,088.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,242.82
|
| Rate for Payer: Quartz Commercial |
$3,970.80
|
| Rate for Payer: WEA Trust Commercial |
$3,639.90
|
| Rate for Payer: WPS Commercial |
$4,901.95
|
|
|
BLADDER SLING OBTRYX II HALO TAPE 850-511
|
Facility
IP
|
$8,081.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3219463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.69 |
| Max. Negotiated Rate |
$7,434.52 |
| Rate for Payer: Aetna Commercial |
$7,272.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.93
|
| Rate for Payer: Cash Price |
$2,424.30
|
| Rate for Payer: Cigna Commercial |
$7,434.52
|
| Rate for Payer: Health EOS Commercial |
$7,192.09
|
| Rate for Payer: HFN Commercial |
$7,434.52
|
| Rate for Payer: Multiplan Commercial |
$6,464.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,434.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.69
|
| Rate for Payer: Quartz Commercial |
$4,848.60
|
| Rate for Payer: WEA Trust Commercial |
$4,444.55
|
| Rate for Payer: WPS Commercial |
$5,985.60
|
|
|
BLADDER SLING OBTRYX II HALO TAPE 850-511
|
Facility
OP
|
$8,081.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3219463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.68 |
| Max. Negotiated Rate |
$7,434.52 |
| Rate for Payer: Aetna Commercial |
$7,272.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,949.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.93
|
| Rate for Payer: Cash Price |
$2,424.30
|
| Rate for Payer: Cigna Commercial |
$7,434.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,522.13
|
| Rate for Payer: Health EOS Commercial |
$7,192.09
|
| Rate for Payer: HFN Commercial |
$7,434.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.75
|
| Rate for Payer: Multiplan Commercial |
$6,464.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,434.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.69
|
| Rate for Payer: Quartz Commercial |
$5,252.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.60
|
| Rate for Payer: WEA Trust Commercial |
$4,444.55
|
| Rate for Payer: WPS Commercial |
$5,985.60
|
|
|
BLADDER SLING OBTRYX TAPE 850-500
|
Facility
IP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2975074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.50 |
| Max. Negotiated Rate |
$6,762.00 |
| Rate for Payer: NAPHCARE Commercial |
$4,410.00
|
| Rate for Payer: Aetna Commercial |
$6,615.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,895.50
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cigna Commercial |
$6,762.00
|
| Rate for Payer: Health EOS Commercial |
$6,541.50
|
| Rate for Payer: HFN Commercial |
$6,762.00
|
| Rate for Payer: Multiplan Commercial |
$5,880.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,762.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,601.50
|
| Rate for Payer: Quartz Commercial |
$4,410.00
|
| Rate for Payer: WEA Trust Commercial |
$4,042.50
|
| Rate for Payer: WPS Commercial |
$5,444.14
|
|
|
BLADDER SLING OBTRYX TAPE 850-500
|
Facility
OP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2975074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,058.00 |
| Max. Negotiated Rate |
$6,762.00 |
| Rate for Payer: Aetna Commercial |
$6,615.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,321.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,058.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,777.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,528.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,895.50
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cigna Commercial |
$6,762.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,113.06
|
| Rate for Payer: Health EOS Commercial |
$6,541.50
|
| Rate for Payer: HFN Commercial |
$6,762.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,512.50
|
| Rate for Payer: Multiplan Commercial |
$5,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,410.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,762.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,601.50
|
| Rate for Payer: Quartz Commercial |
$4,777.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,410.00
|
| Rate for Payer: WEA Trust Commercial |
$4,042.50
|
| Rate for Payer: WPS Commercial |
$5,444.14
|
|
|
BLADDER SLING PROCEDURE
|
Facility
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2959848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,227.24 |
| Max. Negotiated Rate |
$17,532.00 |
| Rate for Payer: Aetna Commercial |
$3,944.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,769.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,848.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,103.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,322.99
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,032.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,452.73
|
| Rate for Payer: Health EOS Commercial |
$3,900.87
|
| Rate for Payer: HFN Commercial |
$4,032.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,287.25
|
| Rate for Payer: Multiplan Commercial |
$3,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,629.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,032.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,147.67
|
| Rate for Payer: Quartz Commercial |
$2,848.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,629.80
|
| Rate for Payer: The Alliance Commercial |
$17,532.00
|
| Rate for Payer: WEA Trust Commercial |
$2,410.65
|
| Rate for Payer: WPS Commercial |
$3,246.49
|
|
|
BLADDER SLING PROCEDURE
|
Facility
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2959848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,147.67 |
| Max. Negotiated Rate |
$4,032.36 |
| Rate for Payer: Aetna Commercial |
$3,944.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,322.99
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,032.36
|
| Rate for Payer: Health EOS Commercial |
$3,900.87
|
| Rate for Payer: HFN Commercial |
$4,032.36
|
| Rate for Payer: Multiplan Commercial |
$3,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,629.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,032.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,147.67
|
| Rate for Payer: Quartz Commercial |
$2,629.80
|
| Rate for Payer: WEA Trust Commercial |
$2,410.65
|
| Rate for Payer: WPS Commercial |
$3,246.49
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE MESH MECHANICAL CUT 810041B
|
Facility
OP
|
$7,953.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
5384772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.84 |
| Max. Negotiated Rate |
$7,316.76 |
| Rate for Payer: Aetna Commercial |
$7,157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,839.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,226.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,169.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,976.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,817.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,215.09
|
| Rate for Payer: Cash Price |
$2,385.90
|
| Rate for Payer: Cigna Commercial |
$7,316.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,450.50
|
| Rate for Payer: Health EOS Commercial |
$7,078.17
|
| Rate for Payer: HFN Commercial |
$7,316.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,964.75
|
| Rate for Payer: Multiplan Commercial |
$6,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,316.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,896.97
|
| Rate for Payer: Quartz Commercial |
$5,169.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,771.80
|
| Rate for Payer: WEA Trust Commercial |
$4,374.15
|
| Rate for Payer: WPS Commercial |
$5,890.79
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE MESH MECHANICAL CUT 810041B
|
Facility
IP
|
$7,953.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
5384772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,896.97 |
| Max. Negotiated Rate |
$7,316.76 |
| Rate for Payer: Aetna Commercial |
$7,157.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,215.09
|
| Rate for Payer: Cash Price |
$2,385.90
|
| Rate for Payer: Cigna Commercial |
$7,316.76
|
| Rate for Payer: Health EOS Commercial |
$7,078.17
|
| Rate for Payer: HFN Commercial |
$7,316.76
|
| Rate for Payer: Multiplan Commercial |
$6,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,316.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,896.97
|
| Rate for Payer: Quartz Commercial |
$4,771.80
|
| Rate for Payer: WEA Trust Commercial |
$4,374.15
|
| Rate for Payer: WPS Commercial |
$5,890.79
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE SUPPORT WITH ABDOMINAL GUIDE 810041A
|
Facility
IP
|
$7,843.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2965768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,843.07 |
| Max. Negotiated Rate |
$7,215.56 |
| Rate for Payer: Aetna Commercial |
$7,058.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,156.79
|
| Rate for Payer: Cash Price |
$2,352.90
|
| Rate for Payer: Cigna Commercial |
$7,215.56
|
| Rate for Payer: Health EOS Commercial |
$6,980.27
|
| Rate for Payer: HFN Commercial |
$7,215.56
|
| Rate for Payer: Multiplan Commercial |
$6,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,705.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,215.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,843.07
|
| Rate for Payer: Quartz Commercial |
$4,705.80
|
| Rate for Payer: WEA Trust Commercial |
$4,313.65
|
| Rate for Payer: WPS Commercial |
$5,809.31
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE SUPPORT WITH ABDOMINAL GUIDE 810041A
|
Facility
OP
|
$7,843.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2965768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,196.04 |
| Max. Negotiated Rate |
$7,215.56 |
| Rate for Payer: Aetna Commercial |
$7,058.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,744.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,196.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,097.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,921.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,764.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,156.79
|
| Rate for Payer: Cash Price |
$2,352.90
|
| Rate for Payer: Cigna Commercial |
$7,215.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,388.94
|
| Rate for Payer: Health EOS Commercial |
$6,980.27
|
| Rate for Payer: HFN Commercial |
$7,215.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,882.25
|
| Rate for Payer: Multiplan Commercial |
$6,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,705.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,215.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,843.07
|
| Rate for Payer: Quartz Commercial |
$5,097.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,705.80
|
| Rate for Payer: WEA Trust Commercial |
$4,313.65
|
| Rate for Payer: WPS Commercial |
$5,809.31
|
|
|
BLADDER TUMOR, TRANSURETHRAL RESECTION
|
Facility
IP
|
$5,017.00
|
|
| Hospital Charge Code |
2960458
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,458.33 |
| Max. Negotiated Rate |
$4,615.64 |
| Rate for Payer: Aetna Commercial |
$4,515.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,659.01
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,615.64
|
| Rate for Payer: Health EOS Commercial |
$4,465.13
|
| Rate for Payer: HFN Commercial |
$4,615.64
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,010.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,615.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,458.33
|
| Rate for Payer: Quartz Commercial |
$3,010.20
|
| Rate for Payer: WEA Trust Commercial |
$2,759.35
|
| Rate for Payer: WPS Commercial |
$3,716.09
|
|
|
BLADDER TUMOR, TRANSURETHRAL RESECTION
|
Facility
OP
|
$5,017.00
|
|
| Hospital Charge Code |
2960458
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,404.76 |
| Max. Negotiated Rate |
$20,068.00 |
| Rate for Payer: Aetna Commercial |
$4,515.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,314.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,404.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,261.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,508.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,408.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,659.01
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,615.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,807.51
|
| Rate for Payer: Health EOS Commercial |
$4,465.13
|
| Rate for Payer: HFN Commercial |
$4,615.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,762.75
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,010.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,615.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,458.33
|
| Rate for Payer: Quartz Commercial |
$3,261.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,010.20
|
| Rate for Payer: The Alliance Commercial |
$20,068.00
|
| Rate for Payer: WEA Trust Commercial |
$2,759.35
|
| Rate for Payer: WPS Commercial |
$3,716.09
|
|
|
BLADE 10MM FLEXIBLE OSTEOTOME 71369210
|
Facility
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2965974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$969.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
BLADE 10MM FLEXIBLE OSTEOTOME 71369210
|
Facility
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2965974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$6,460.00 |
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.75
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.25
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$1,049.75
|
| Rate for Payer: Quartz Medicare Advantage |
$969.00
|
| Rate for Payer: The Alliance Commercial |
$6,460.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
BLADE 12MM FLEXIBLE OSTEOTOME 71369212
|
Facility
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2965976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,431.52 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$933.60
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
BLADE 12MM FLEXIBLE OSTEOTOME 71369212
|
Facility
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2965976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$6,224.00 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Aetna Managed Medicare |
$435.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.74
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$1,011.40
|
| Rate for Payer: Quartz Medicare Advantage |
$933.60
|
| Rate for Payer: The Alliance Commercial |
$6,224.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
BLADE 12MM FLEX OSTEOTOME RND 71369412
|
Facility
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2965975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$6,224.00 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Aetna Managed Medicare |
$435.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.74
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$1,011.40
|
| Rate for Payer: Quartz Medicare Advantage |
$933.60
|
| Rate for Payer: The Alliance Commercial |
$6,224.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
BLADE 12MM FLEX OSTEOTOME RND 71369412
|
Facility
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2965975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,431.52 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$933.60
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
