|
CONDITIONING PLAY AUDIOMETRY 92582
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
3015338
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$574.33 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
CONDITIONING PLAY AUDIOMETRY 92582
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
3015338
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
CONDYLOMA, CAUTERY OF
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CONDYLOMA, CAUTERY OF
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CONE STOMA W/ CONNECTOR 7723
|
Facility
OP
|
$125.00
|
|
| Hospital Charge Code |
2964029
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$35.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.95
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$81.25
|
| Rate for Payer: Quartz Medicare Advantage |
$75.00
|
| Rate for Payer: The Alliance Commercial |
$500.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
CONE STOMA W/ CONNECTOR 7723
|
Facility
IP
|
$125.00
|
|
| Hospital Charge Code |
2964029
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
CONIZATION OF CERVIX 57520
|
Professional
|
$1,731.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
3015091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$1,644.45 |
| Rate for Payer: Aetna Commercial |
$1,644.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.66
|
| Rate for Payer: Aetna Managed Medicare |
$279.68
|
| Rate for Payer: Anthem Medicare Advantage |
$279.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$279.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$279.68
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,644.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$865.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.68
|
| Rate for Payer: Health EOS Commercial |
$1,575.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$279.68
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,644.45
|
| Rate for Payer: Quartz Beloit One Network |
$761.64
|
| Rate for Payer: Quartz Commercial |
$986.67
|
| Rate for Payer: Quartz Medicare Advantage |
$279.68
|
| Rate for Payer: The Alliance Commercial |
$1,188.64
|
| Rate for Payer: United Healthcare Medicaid |
$271.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.68
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,258.56
|
|
|
Conization of Cervix 5752022
|
Professional
|
$2,076.00
|
|
|
Service Code
|
CPT 57520 22
|
| Hospital Charge Code |
5296606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$913.44 |
| Max. Negotiated Rate |
$1,972.20 |
| Rate for Payer: Aetna Commercial |
$1,972.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,785.36
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$1,972.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,038.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,245.60
|
| Rate for Payer: Health EOS Commercial |
$1,889.16
|
| Rate for Payer: Multiplan Commercial |
$1,660.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,972.20
|
| Rate for Payer: Quartz Beloit One Network |
$913.44
|
| Rate for Payer: Quartz Commercial |
$1,183.32
|
| Rate for Payer: The Alliance Commercial |
$1,038.00
|
| Rate for Payer: WEA Trust Commercial |
$1,141.80
|
| Rate for Payer: WPS Commercial |
$1,537.69
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
OP
|
$14,735.44
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$14,735.44 |
| 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 |
$4,757.59
|
| 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 |
$14,735.44
|
| 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
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
OP
|
$11,495.25
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$11,495.25 |
| 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 |
$4,757.59
|
| 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 |
$8,905.92
|
| 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
|
|
|
Conjugated Estrogen Vaginal Cream [Med]
|
Facility
IP
|
$955.00
|
|
| Hospital Charge Code |
2974974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$467.95 |
| Max. Negotiated Rate |
$878.60 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.15
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$878.60
|
| Rate for Payer: Health EOS Commercial |
$849.95
|
| Rate for Payer: HFN Commercial |
$878.60
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$878.60
|
| Rate for Payer: Quartz Beloit One Network |
$467.95
|
| Rate for Payer: Quartz Commercial |
$573.00
|
| Rate for Payer: WEA Trust Commercial |
$525.25
|
| Rate for Payer: WPS Commercial |
$707.37
|
|
|
Conjugated Estrogen Vaginal Cream [Med]
|
Facility
OP
|
$955.00
|
|
| Hospital Charge Code |
2974974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$3,820.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.30
|
| Rate for Payer: Aetna Managed Medicare |
$267.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$620.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.15
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$878.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.42
|
| Rate for Payer: Health EOS Commercial |
$849.95
|
| Rate for Payer: HFN Commercial |
$878.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.25
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$878.60
|
| Rate for Payer: Quartz Beloit One Network |
$467.95
|
| Rate for Payer: Quartz Commercial |
$620.75
|
| Rate for Payer: Quartz Medicare Advantage |
$573.00
|
| Rate for Payer: The Alliance Commercial |
$3,820.00
|
| Rate for Payer: WEA Trust Commercial |
$525.25
|
| Rate for Payer: WPS Commercial |
$707.37
|
|
|
CONNECTING NUT LONG M8 X 15MM HOFFMANN LIMB 4933-1-011
|
Facility
OP
|
$424.00
|
|
| Hospital Charge Code |
6181533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.72 |
| Max. Negotiated Rate |
$1,696.00 |
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.64
|
| Rate for Payer: Aetna Managed Medicare |
$118.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$275.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$203.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.72
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$390.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.27
|
| Rate for Payer: Health EOS Commercial |
$377.36
|
| Rate for Payer: HFN Commercial |
$390.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$318.00
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: NAPHCARE Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$390.08
|
| Rate for Payer: Quartz Beloit One Network |
$207.76
|
| Rate for Payer: Quartz Commercial |
$275.60
|
| Rate for Payer: Quartz Medicare Advantage |
$254.40
|
| Rate for Payer: The Alliance Commercial |
$1,696.00
|
| Rate for Payer: WEA Trust Commercial |
$233.20
|
| Rate for Payer: WPS Commercial |
$314.06
|
|
|
CONNECTING NUT LONG M8 X 15MM HOFFMANN LIMB 4933-1-011
|
Facility
IP
|
$424.00
|
|
| Hospital Charge Code |
6181533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.76 |
| Max. Negotiated Rate |
$390.08 |
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.72
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$390.08
|
| Rate for Payer: Health EOS Commercial |
$377.36
|
| Rate for Payer: HFN Commercial |
$390.08
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: NAPHCARE Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$390.08
|
| Rate for Payer: Quartz Beloit One Network |
$207.76
|
| Rate for Payer: Quartz Commercial |
$254.40
|
| Rate for Payer: WEA Trust Commercial |
$233.20
|
| Rate for Payer: WPS Commercial |
$314.06
|
|
|
CONNECTING NUT SHORT M8 X 6MM HOFFMANN LIMB 4933-1-010
|
Facility
OP
|
$368.00
|
|
| Hospital Charge Code |
5599713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$103.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.93
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$239.20
|
| Rate for Payer: Quartz Medicare Advantage |
$220.80
|
| Rate for Payer: The Alliance Commercial |
$1,472.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
CONNECTING NUT SHORT M8 X 6MM HOFFMANN LIMB 4933-1-010
|
Facility
IP
|
$368.00
|
|
| Hospital Charge Code |
5599713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$220.80
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
CONNECTING TUBE 30CM FOR 3FR - 6FR CATHETERS M0067401000
|
Facility
IP
|
$290.00
|
|
| Hospital Charge Code |
5349546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
CONNECTING TUBE 30CM FOR 3FR - 6FR CATHETERS M0067401000
|
Facility
OP
|
$290.00
|
|
| Hospital Charge Code |
5349546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$174.00
|
| Rate for Payer: The Alliance Commercial |
$1,160.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$32,205.00
|
|
|
Service Code
|
MS-DRG 546
|
| Min. Negotiated Rate |
$11,584.53 |
| Max. Negotiated Rate |
$32,205.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,584.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,584.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,584.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,584.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,584.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,584.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,386.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,584.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,584.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,584.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,584.53
|
| Rate for Payer: NAPHCARE Commercial |
$17,376.80
|
| Rate for Payer: Quartz Medicare Advantage |
$11,584.53
|
| Rate for Payer: The Alliance Commercial |
$32,205.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,584.53
|
| Rate for Payer: United Healthcare PPO |
$18,206.57
|
| Rate for Payer: Wellcare Medicare |
$11,584.53
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$66,605.00
|
|
|
Service Code
|
MS-DRG 545
|
| Min. Negotiated Rate |
$23,958.47 |
| Max. Negotiated Rate |
$66,605.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,958.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52,240.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,041.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,042.22
|
| Rate for Payer: Anthem Medicare Advantage |
$23,958.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,958.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,958.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,958.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,230.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,958.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,617.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,958.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,958.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,958.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,958.47
|
| Rate for Payer: NAPHCARE Commercial |
$35,937.70
|
| Rate for Payer: Quartz Medicare Advantage |
$23,958.47
|
| Rate for Payer: The Alliance Commercial |
$66,605.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,958.47
|
| Rate for Payer: United Healthcare PPO |
$37,849.27
|
| Rate for Payer: Wellcare Medicare |
$23,958.47
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$22,209.00
|
|
|
Service Code
|
MS-DRG 547
|
| Min. Negotiated Rate |
$7,988.73 |
| Max. Negotiated Rate |
$22,209.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,988.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,993.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,025.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,375.18
|
| Rate for Payer: Anthem Medicare Advantage |
$7,988.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,988.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,988.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,988.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,737.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,988.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,861.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,988.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,988.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,988.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,988.73
|
| Rate for Payer: NAPHCARE Commercial |
$11,983.10
|
| Rate for Payer: Quartz Medicare Advantage |
$7,988.73
|
| Rate for Payer: The Alliance Commercial |
$22,209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,988.73
|
| Rate for Payer: United Healthcare PPO |
$12,348.23
|
| Rate for Payer: Wellcare Medicare |
$7,988.73
|
|
|
CONNECTOR 1/2x1/2 C140S
|
Facility
IP
|
$186.00
|
|
| Hospital Charge Code |
2965779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
CONNECTOR 1/2x1/2 C140S
|
Facility
OP
|
$186.00
|
|
| Hospital Charge Code |
2965779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
CONNECTOR 1/2x1/2x1/2 C340S
|
Facility
IP
|
$186.00
|
|
| Hospital Charge Code |
2965780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
CONNECTOR 1/2x1/2x1/2 C340S
|
Facility
OP
|
$186.00
|
|
| Hospital Charge Code |
2965780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
