|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,905.76
|
| 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.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 |
$1,100.00 |
| 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: The Alliance Commercial |
$1,100.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| 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 URETHERAL 10 FR 40-0610
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
CATH URETHERAL 10 FR 40-0610
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS A4351
|
| Hospital Charge Code |
2963443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| 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
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
3014363
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$685.28 |
| Rate for Payer: Aetna Commercial |
$383.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| 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 |
$51.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.40
|
| Rate for Payer: Health EOS Commercial |
$367.64
|
| Rate for Payer: HFN Commercial |
$383.80
|
| 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: 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: The Alliance Commercial |
$202.00
|
| Rate for Payer: United Healthcare Medicaid |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
CAUTERIZATION, INNER NOSE 3080250
|
Professional
|
Both
|
$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: HFN Commercial |
$768.55
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| 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 PTFE COATED TIP 6.5 E1455-6
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
3072363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| 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: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| 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 |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
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
|
|
|
CAUTERY HI TEMP FINE TIP AA01
|
Facility
|
IP
|
$232.00
|
|
| Hospital Charge Code |
2974723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$213.44 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$139.20
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
CAUTERY HI TEMP FINE TIP AA01
|
Facility
|
OP
|
$232.00
|
|
| Hospital Charge Code |
2974723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$928.00 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Aetna Managed Medicare |
$64.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.83
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.00
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$150.80
|
| Rate for Payer: Quartz Medicare Advantage |
$139.20
|
| Rate for Payer: The Alliance Commercial |
$928.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Cautery Of Cervix
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
1190839
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: HFN Commercial |
$529.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$374.92
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: United Healthcare Medicaid |
$63.35
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
CAUTERY OF CERVIX; ELECTRO OR THERMAL
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 57510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
CAUTERY PENCIL SMOKE EVACUATION WITH TELESCOPING CANNULA (GRAY SWIVEL) CVPLP2000
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
5685787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Aetna Managed Medicare |
$227.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.51
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.50
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$529.10
|
| Rate for Payer: Quartz Medicare Advantage |
$488.40
|
| Rate for Payer: The Alliance Commercial |
$3,256.00
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
CAUTERY PENCIL SMOKE EVACUATION WITH TELESCOPING CANNULA (GRAY SWIVEL) CVPLP2000
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
5685787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.86 |
| Max. Negotiated Rate |
$748.88 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$488.40
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
CAUTERY PENCIL VALLEYLAB TELESCOPING SMOKE EVACUATION ROCKER SWITCH (BLUE SWIVEL) SEP6015
|
Facility
|
IP
|
$766.00
|
|
| Hospital Charge Code |
5641689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.34 |
| Max. Negotiated Rate |
$704.72 |
| Rate for Payer: Aetna Commercial |
$689.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$704.72
|
| Rate for Payer: Health EOS Commercial |
$681.74
|
| Rate for Payer: HFN Commercial |
$704.72
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: NAPHCARE Commercial |
$459.60
|
| Rate for Payer: Preferred Network Access Commercial |
$704.72
|
| Rate for Payer: Quartz Beloit One Network |
$375.34
|
| Rate for Payer: Quartz Commercial |
$459.60
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
|
CAUTERY PENCIL VALLEYLAB TELESCOPING SMOKE EVACUATION ROCKER SWITCH (BLUE SWIVEL) SEP6015
|
Facility
|
OP
|
$766.00
|
|
| Hospital Charge Code |
5641689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.48 |
| Max. Negotiated Rate |
$3,064.00 |
| Rate for Payer: Aetna Commercial |
$689.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Aetna Managed Medicare |
$214.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$497.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$367.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$704.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.65
|
| Rate for Payer: Health EOS Commercial |
$681.74
|
| Rate for Payer: HFN Commercial |
$704.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.50
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: NAPHCARE Commercial |
$459.60
|
| Rate for Payer: Preferred Network Access Commercial |
$704.72
|
| Rate for Payer: Quartz Beloit One Network |
$375.34
|
| Rate for Payer: Quartz Commercial |
$497.90
|
| Rate for Payer: Quartz Medicare Advantage |
$459.60
|
| Rate for Payer: The Alliance Commercial |
$3,064.00
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
