|
Bright Tip 8Fr 55cm
|
Facility
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Bright Tip 8Fr 55cm
|
Professional
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Bright Tip 8Fr 55cm
|
Facility
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Bright Tip 8Fr 90cm
|
Facility
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Bright Tip 8Fr 90cm
|
Facility
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Bright Tip 8Fr 90cm
|
Professional
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Brinzolamide 1% Ophth Suspension 5ml [Med]
|
Facility
OP
|
$841.00
|
|
| Hospital Charge Code |
2974910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$3,364.00 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Aetna Managed Medicare |
$235.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.62
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.75
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$546.65
|
| Rate for Payer: Quartz Medicare Advantage |
$504.60
|
| Rate for Payer: The Alliance Commercial |
$3,364.00
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
Brinzolamide 1% Ophth Suspension 5ml [Med]
|
Facility
IP
|
$841.00
|
|
| Hospital Charge Code |
2974910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$412.09 |
| Max. Negotiated Rate |
$773.72 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$504.60
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
Brivaracetam Level
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5613548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$154.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$331.20
|
| Rate for Payer: United Healthcare PPO |
$414.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
Brivaracetam Level
|
Professional
|
$552.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5613548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$242.88
|
| Rate for Payer: Quartz Commercial |
$314.64
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
Brivaracetam Level
|
Facility
IP
|
$552.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5613548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$331.20
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
BROACH M.I.B. 317-00-006
|
Facility
OP
|
$2,516.00
|
|
| Hospital Charge Code |
5506862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.48 |
| Max. Negotiated Rate |
$10,064.00 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Aetna Managed Medicare |
$704.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,635.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.95
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,887.00
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,635.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,509.60
|
| Rate for Payer: The Alliance Commercial |
$10,064.00
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
BROACH M.I.B. 317-00-006
|
Facility
IP
|
$2,516.00
|
|
| Hospital Charge Code |
5506862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,232.84 |
| Max. Negotiated Rate |
$2,314.72 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,509.60
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
Bronchial Dble-Lumen Tubes
|
Facility
IP
|
$1,512.00
|
|
| Hospital Charge Code |
3101741
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$740.88 |
| Max. Negotiated Rate |
$1,391.04 |
| Rate for Payer: Aetna Commercial |
$1,360.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.36
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$1,391.04
|
| Rate for Payer: Health EOS Commercial |
$1,345.68
|
| Rate for Payer: HFN Commercial |
$1,391.04
|
| Rate for Payer: Multiplan Commercial |
$1,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$907.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.04
|
| Rate for Payer: Quartz Beloit One Network |
$740.88
|
| Rate for Payer: Quartz Commercial |
$907.20
|
| Rate for Payer: WEA Trust Commercial |
$831.60
|
| Rate for Payer: WPS Commercial |
$1,119.94
|
|
|
Bronchial Dble-Lumen Tubes
|
Facility
OP
|
$1,512.00
|
|
| Hospital Charge Code |
3101741
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$423.36 |
| Max. Negotiated Rate |
$6,048.00 |
| Rate for Payer: Aetna Commercial |
$1,360.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,300.32
|
| Rate for Payer: Aetna Managed Medicare |
$423.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.36
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$1,391.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.12
|
| Rate for Payer: Health EOS Commercial |
$1,345.68
|
| Rate for Payer: HFN Commercial |
$1,391.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$907.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.04
|
| Rate for Payer: Quartz Beloit One Network |
$740.88
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: Quartz Medicare Advantage |
$907.20
|
| Rate for Payer: The Alliance Commercial |
$6,048.00
|
| Rate for Payer: WEA Trust Commercial |
$831.60
|
| Rate for Payer: WPS Commercial |
$1,119.94
|
|
|
Bronchial Provocation Test - Pulmonary Function Test Charge
|
Facility
OP
|
$900.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
3006999
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,154.09 |
| Rate for Payer: Aetna Commercial |
$810.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.00
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.00
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$828.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$503.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$801.00
|
| Rate for Payer: HFN Commercial |
$828.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$828.00
|
| Rate for Payer: Quartz Beloit One Network |
$441.00
|
| Rate for Payer: Quartz Commercial |
$585.00
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$675.00
|
| Rate for Payer: WEA Trust Commercial |
$495.00
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$666.63
|
|
|
Bronchial Provocation Test - Pulmonary Function Test Charge
|
Facility
IP
|
$900.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
3006999
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$810.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$828.00
|
| Rate for Payer: Health EOS Commercial |
$801.00
|
| Rate for Payer: HFN Commercial |
$828.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: NAPHCARE Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$828.00
|
| Rate for Payer: Quartz Beloit One Network |
$441.00
|
| Rate for Payer: Quartz Commercial |
$540.00
|
| Rate for Payer: WEA Trust Commercial |
$495.00
|
| Rate for Payer: WPS Commercial |
$666.63
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
IP
|
$25,776.00
|
|
|
Service Code
|
MS-DRG 202
|
| Min. Negotiated Rate |
$9,272.11 |
| Max. Negotiated Rate |
$25,776.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,272.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,140.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,437.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,666.88
|
| Rate for Payer: Anthem Medicare Advantage |
$9,272.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,272.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,272.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,272.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,281.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,272.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,671.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,272.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,272.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,272.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,272.11
|
| Rate for Payer: NAPHCARE Commercial |
$13,908.16
|
| Rate for Payer: Quartz Medicare Advantage |
$9,272.11
|
| Rate for Payer: The Alliance Commercial |
$25,776.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,272.11
|
| Rate for Payer: United Healthcare PPO |
$14,535.81
|
| Rate for Payer: Wellcare Medicare |
$9,272.11
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
IP
|
$18,795.00
|
|
|
Service Code
|
MS-DRG 203
|
| Min. Negotiated Rate |
$6,760.79 |
| Max. Negotiated Rate |
$18,795.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,760.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,476.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,095.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,541.82
|
| Rate for Payer: Anthem Medicare Advantage |
$6,760.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,760.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,760.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,760.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,702.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,760.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,550.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,760.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,760.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,760.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,760.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,141.18
|
| Rate for Payer: Quartz Medicare Advantage |
$6,760.79
|
| Rate for Payer: The Alliance Commercial |
$18,795.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,760.79
|
| Rate for Payer: United Healthcare PPO |
$10,549.28
|
| Rate for Payer: Wellcare Medicare |
$6,760.79
|
|
|
BRONCHO/LARYNGO/NASOPHANGO/ESOPHAGOSCOPY
|
Facility
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2960333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$8,204.00 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Aetna Managed Medicare |
$574.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.74
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.25
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.60
|
| Rate for Payer: The Alliance Commercial |
$8,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
BRONCHO/LARYNGO/NASOPHANGO/ESOPHAGOSCOPY
|
Facility
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2960333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,004.99 |
| Max. Negotiated Rate |
$1,886.92 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,230.60
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
BRONCHOSCOPE GLIDESCOPE BFLEX 2.8MM SINGLE-USE 0570-0447
|
Facility
IP
|
$3,215.00
|
|
| Hospital Charge Code |
6178757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,575.35 |
| Max. Negotiated Rate |
$2,957.80 |
| Rate for Payer: Aetna Commercial |
$2,893.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,703.95
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$2,957.80
|
| Rate for Payer: Health EOS Commercial |
$2,861.35
|
| Rate for Payer: HFN Commercial |
$2,957.80
|
| Rate for Payer: Multiplan Commercial |
$2,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,957.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,575.35
|
| Rate for Payer: Quartz Commercial |
$1,929.00
|
| Rate for Payer: WEA Trust Commercial |
$1,768.25
|
| Rate for Payer: WPS Commercial |
$2,381.35
|
|
|
BRONCHOSCOPE GLIDESCOPE BFLEX 2.8MM SINGLE-USE 0570-0447
|
Facility
OP
|
$3,215.00
|
|
| Hospital Charge Code |
6178757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$12,860.00 |
| Rate for Payer: Aetna Commercial |
$2,893.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,764.90
|
| Rate for Payer: Aetna Managed Medicare |
$900.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,089.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,607.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,543.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,703.95
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$2,957.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,799.11
|
| Rate for Payer: Health EOS Commercial |
$2,861.35
|
| Rate for Payer: HFN Commercial |
$2,957.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,411.25
|
| Rate for Payer: Multiplan Commercial |
$2,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,957.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,575.35
|
| Rate for Payer: Quartz Commercial |
$2,089.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,929.00
|
| Rate for Payer: The Alliance Commercial |
$12,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,768.25
|
| Rate for Payer: WPS Commercial |
$2,381.35
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0380
|
Facility
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5685759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0380
|
Facility
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5685759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
