|
CATH THORACIC 8FR 8008
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
4998736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CATH THROMBECTOMY SYNTEL FOGARTY 4F X 50CM A4545
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
6207018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.39 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,191.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$880.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$916.76
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
CATH THROMBECTOMY SYNTEL FOGARTY 4F X 50CM A4545
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
6207018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
|
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.30 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Aetna Managed Medicare |
$645.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.71
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,728.48
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,498.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,382.78
|
| Rate for Payer: The Alliance Commercial |
$1,152.32
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
CATH TRAY MAHURKAR CVD 12FR X 20CM 888222320
|
Facility
|
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.27 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,382.78
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
|
IP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.80 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,319.76
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
CATH TRAY MAHURKAR CVD 12 X 13CM 888222313
|
Facility
|
OP
|
$2,115.00
|
|
| Hospital Charge Code |
2963065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.89 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Aetna Managed Medicare |
$615.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,429.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.93
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,649.70
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,319.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,429.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,319.76
|
| Rate for Payer: The Alliance Commercial |
$1,099.80
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
CATH TRAY MAHURKAR STR 12FR X 13.0 8888221313
|
Facility
|
IP
|
$2,198.00
|
|
| Hospital Charge Code |
2963063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.10 |
| Max. Negotiated Rate |
$2,103.05 |
| Rate for Payer: Aetna Commercial |
$2,057.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.54
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,103.05
|
| Rate for Payer: Health EOS Commercial |
$2,034.47
|
| Rate for Payer: HFN Commercial |
$2,103.05
|
| Rate for Payer: Multiplan Commercial |
$1,828.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.10
|
| Rate for Payer: Quartz Commercial |
$1,371.55
|
| Rate for Payer: WEA Trust Commercial |
$1,257.26
|
| Rate for Payer: WPS Commercial |
$1,693.12
|
|
|
CATH TRAY MAHURKAR STR 12FR X 13.0 8888221313
|
Facility
|
OP
|
$2,198.00
|
|
| Hospital Charge Code |
2963063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$2,103.05 |
| Rate for Payer: Aetna Commercial |
$2,057.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| Rate for Payer: Aetna Managed Medicare |
$640.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,485.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,142.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.54
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,103.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$2,034.47
|
| Rate for Payer: HFN Commercial |
$2,103.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,714.44
|
| Rate for Payer: Multiplan Commercial |
$1,828.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,371.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.10
|
| Rate for Payer: Quartz Commercial |
$1,485.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,371.55
|
| Rate for Payer: The Alliance Commercial |
$1,142.96
|
| Rate for Payer: WEA Trust Commercial |
$1,257.26
|
| Rate for Payer: WPS Commercial |
$1,693.12
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
|
IP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.27 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,382.78
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
CATH TRAY MAHURKAR STR 12FR X 20CM 8888221320
|
Facility
|
OP
|
$2,216.00
|
|
| Hospital Charge Code |
2963066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.30 |
| Max. Negotiated Rate |
$2,120.27 |
| Rate for Payer: Aetna Commercial |
$2,074.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.99
|
| Rate for Payer: Aetna Managed Medicare |
$645.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.46
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cigna Commercial |
$2,120.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.71
|
| Rate for Payer: Health EOS Commercial |
$2,051.13
|
| Rate for Payer: HFN Commercial |
$2,120.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,728.48
|
| Rate for Payer: Multiplan Commercial |
$1,843.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.27
|
| Rate for Payer: Quartz Commercial |
$1,498.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,382.78
|
| Rate for Payer: The Alliance Commercial |
$1,152.32
|
| Rate for Payer: WEA Trust Commercial |
$1,267.55
|
| Rate for Payer: WPS Commercial |
$1,706.98
|
|
|
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 |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
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 |
$80.08 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$80.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$171.60
|
| Rate for Payer: The Alliance Commercial |
$143.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
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 |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
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 |
$8.44 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$18.10
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.10
|
| Rate for Payer: The Alliance Commercial |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
CAUDAL BLOCK - SET-UP CHARGE
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
4519592
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.68 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Aetna Managed Medicare |
$66.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.28
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.62
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$142.90
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: Quartz Medicare Advantage |
$142.90
|
| Rate for Payer: The Alliance Commercial |
$119.08
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
CAUDAL BLOCK - SET-UP CHARGE
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
4519592
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$142.90
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
CAUTERIZATION, INNER NOSE 30802
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
3014363
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$805.99 |
| Rate for Payer: Aetna Commercial |
$399.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$179.11
|
| Rate for Payer: Anthem Medicare Advantage |
$179.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.11
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$399.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.11
|
| Rate for Payer: Health EOS Commercial |
$382.35
|
| Rate for Payer: HFN Commercial |
$399.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$712.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$712.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.11
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$268.66
|
| Rate for Payer: Preferred Network Access Commercial |
$399.15
|
| Rate for Payer: Quartz Beloit One Network |
$184.87
|
| Rate for Payer: Quartz Commercial |
$239.49
|
| Rate for Payer: Quartz Medicare Advantage |
$179.11
|
| Rate for Payer: The Alliance Commercial |
$761.21
|
| Rate for Payer: United Healthcare Medicaid |
$53.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.11
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$805.99
|
|
|
CAUTERIZATION, INNER NOSE 3080250
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
CPT 30802 50
|
| Hospital Charge Code |
5492801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$799.29 |
| Rate for Payer: Aetna Commercial |
$799.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$799.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.82
|
| Rate for Payer: Health EOS Commercial |
$765.64
|
| Rate for Payer: HFN Commercial |
$799.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$712.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$712.69
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: Preferred Network Access Commercial |
$799.29
|
| Rate for Payer: Quartz Beloit One Network |
$370.20
|
| Rate for Payer: Quartz Commercial |
$479.58
|
| Rate for Payer: The Alliance Commercial |
$420.68
|
| Rate for Payer: United Healthcare Medicaid |
$53.86
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
CAUTERY ELECTRODE 2.5 TEFLON E-Z CLEAN 0012
|
Facility
|
IP
|
$159.00
|
|
| Hospital Charge Code |
2965538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$99.22
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
CAUTERY ELECTRODE 2.5 TEFLON E-Z CLEAN 0012
|
Facility
|
OP
|
$159.00
|
|
| Hospital Charge Code |
2965538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$46.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.02
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$99.22
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$107.48
|
| Rate for Payer: Quartz Medicare Advantage |
$99.22
|
| Rate for Payer: The Alliance Commercial |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
CAUTERY ELECTRODE COATED BLADE TIP E1455
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2965817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
CAUTERY ELECTRODE COATED BLADE TIP E1455
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2965817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24.96
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
CAUTERY ELECTRODE EXTENDED TIP E1551-6
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
2963060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$79.87
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
CAUTERY ELECTRODE EXTENDED TIP E1551-6
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
2963060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$79.87
|
| Rate for Payer: The Alliance Commercial |
$66.56
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
