|
CATH THERMODILUTION 5 LUMEN 41233-01
|
Facility
OP
|
$985.00
|
|
| Hospital Charge Code |
2963084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$3,940.00 |
| Rate for Payer: Aetna Commercial |
$886.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.10
|
| Rate for Payer: Aetna Managed Medicare |
$275.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$492.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$906.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.21
|
| Rate for Payer: Health EOS Commercial |
$876.65
|
| Rate for Payer: HFN Commercial |
$906.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$738.75
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.00
|
| Rate for Payer: Preferred Network Access Commercial |
$906.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.65
|
| Rate for Payer: Quartz Commercial |
$640.25
|
| Rate for Payer: Quartz Medicare Advantage |
$591.00
|
| Rate for Payer: The Alliance Commercial |
$3,940.00
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$729.59
|
|
|
CATH THERMODILUTION 5 LUMEN 41233-01
|
Facility
IP
|
$985.00
|
|
| Hospital Charge Code |
2963084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.65 |
| Max. Negotiated Rate |
$906.20 |
| Rate for Payer: Aetna Commercial |
$886.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$906.20
|
| Rate for Payer: Health EOS Commercial |
$876.65
|
| Rate for Payer: HFN Commercial |
$906.20
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.00
|
| Rate for Payer: Preferred Network Access Commercial |
$906.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.65
|
| Rate for Payer: Quartz Commercial |
$591.00
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$729.59
|
|
|
CATH THORACIC 12FR 8012
|
Facility
OP
|
$111.00
|
|
| Hospital Charge Code |
4998737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THORACIC 12FR 8012
|
Facility
IP
|
$111.00
|
|
| Hospital Charge Code |
4998737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THORACIC 8FR 8008
|
Facility
OP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH THORACIC 8FR 8008
|
Facility
IP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.84 |
| Max. Negotiated Rate |
$2,038.72 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,329.60
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.48 |
| Max. Negotiated Rate |
$8,864.00 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.76
|
| Rate for Payer: Aetna Managed Medicare |
$620.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,440.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.07
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.00
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,440.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.60
|
| Rate for Payer: The Alliance Commercial |
$8,864.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
IP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.35 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,269.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
OP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.20 |
| Max. Negotiated Rate |
$8,460.00 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Aetna Managed Medicare |
$592.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.55
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.00
|
| Rate for Payer: The Alliance Commercial |
$8,460.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.84 |
| Max. Negotiated Rate |
$2,038.72 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,329.60
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.48 |
| Max. Negotiated Rate |
$8,864.00 |
| Rate for Payer: Aetna Commercial |
$1,994.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.76
|
| Rate for Payer: Aetna Managed Medicare |
$620.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,440.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.48
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,038.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.07
|
| Rate for Payer: Health EOS Commercial |
$1,972.24
|
| Rate for Payer: HFN Commercial |
$2,038.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.00
|
| Rate for Payer: Multiplan Commercial |
$1,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.84
|
| Rate for Payer: Quartz Commercial |
$1,440.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.60
|
| Rate for Payer: The Alliance Commercial |
$8,864.00
|
| Rate for Payer: WEA Trust Commercial |
$1,218.80
|
| Rate for Payer: WPS Commercial |
$1,641.39
|
|
|
CATH.UMBIL ART 3 1/2FR
|
Facility
IP
|
$275.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2963809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
CATH.UMBIL ART 3 1/2FR
|
Facility
OP
|
$275.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2963809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$77.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.89
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.25
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
CAUDAL BLOCK - SET-UP CHARGE
|
Facility
OP
|
$229.00
|
|
| Hospital Charge Code |
4519592
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Aetna Managed Medicare |
$64.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.15
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.75
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$148.85
|
| Rate for Payer: Quartz Medicare Advantage |
$137.40
|
| Rate for Payer: The Alliance Commercial |
$916.00
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
CAUDAL BLOCK - SET-UP CHARGE
|
Facility
IP
|
$229.00
|
|
| Hospital Charge Code |
4519592
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$137.40
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
CAUTERIZATION, INNER NOSE 30802
|
Professional
|
$404.00
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
3014363
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$877.23 |
| Rate for Payer: Aetna Commercial |
$383.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$194.94
|
| Rate for Payer: Anthem Medicare Advantage |
$194.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.94
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$383.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.94
|
| Rate for Payer: Health EOS Commercial |
$367.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$685.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$685.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.94
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.80
|
| Rate for Payer: Quartz Beloit One Network |
$177.76
|
| Rate for Payer: Quartz Commercial |
$230.28
|
| Rate for Payer: Quartz Medicare Advantage |
$194.94
|
| Rate for Payer: The Alliance Commercial |
$828.50
|
| Rate for Payer: United Healthcare Medicaid |
$51.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.94
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$877.23
|
|
|
CAUTERIZATION, INNER NOSE 3080250
|
Professional
|
$809.00
|
|
|
Service Code
|
CPT 30802 50
|
| Hospital Charge Code |
5492801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$355.96 |
| Max. Negotiated Rate |
$768.55 |
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.74
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$768.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$404.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$485.40
|
| Rate for Payer: Health EOS Commercial |
$736.19
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Preferred Network Access Commercial |
$768.55
|
| Rate for Payer: Quartz Beloit One Network |
$355.96
|
| Rate for Payer: Quartz Commercial |
$461.13
|
| Rate for Payer: The Alliance Commercial |
$404.50
|
| Rate for Payer: WEA Trust Commercial |
$444.95
|
| Rate for Payer: WPS Commercial |
$599.23
|
|
|
CAUTERY ELECTRODE 2.5 TEFLON E-Z CLEAN 0012
|
Facility
IP
|
$159.00
|
|
| Hospital Charge Code |
2965538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.91 |
| Max. Negotiated Rate |
$146.28 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.27
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$146.28
|
| Rate for Payer: Health EOS Commercial |
$141.51
|
| Rate for Payer: HFN Commercial |
$146.28
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: NAPHCARE Commercial |
$95.40
|
| Rate for Payer: Preferred Network Access Commercial |
$146.28
|
| Rate for Payer: Quartz Beloit One Network |
$77.91
|
| Rate for Payer: Quartz Commercial |
$95.40
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
CAUTERY ELECTRODE 2.5 TEFLON E-Z CLEAN 0012
|
Facility
OP
|
$159.00
|
|
| Hospital Charge Code |
2965538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.27
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$146.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$141.51
|
| Rate for Payer: HFN Commercial |
$146.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: NAPHCARE Commercial |
$95.40
|
| Rate for Payer: Preferred Network Access Commercial |
$146.28
|
| Rate for Payer: Quartz Beloit One Network |
$77.91
|
| Rate for Payer: Quartz Commercial |
$103.35
|
| Rate for Payer: Quartz Medicare Advantage |
$95.40
|
| Rate for Payer: The Alliance Commercial |
$636.00
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
CAUTERY ELECTRODE COATED BLADE TIP E1455
|
Facility
IP
|
$40.00
|
|
| Hospital Charge Code |
2965817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
CAUTERY ELECTRODE COATED BLADE TIP E1455
|
Facility
OP
|
$40.00
|
|
| Hospital Charge Code |
2965817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Aetna Managed Medicare |
$11.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.38
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$26.00
|
| Rate for Payer: Quartz Medicare Advantage |
$24.00
|
| Rate for Payer: The Alliance Commercial |
$160.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
CAUTERY ELECTRODE EXTENDED TIP E1551-6
|
Facility
IP
|
$128.00
|
|
| Hospital Charge Code |
2963060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
CAUTERY ELECTRODE EXTENDED TIP E1551-6
|
Facility
OP
|
$128.00
|
|
| Hospital Charge Code |
2963060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$35.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$76.80
|
| Rate for Payer: The Alliance Commercial |
$512.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
CAUTERY ELECTRODE PTFE COATED TIP 6.5 E1455-6
|
Facility
OP
|
$138.00
|
|
| Hospital Charge Code |
3072363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
