|
Colposcopy Entire Vagina, w/Cervix if Present w/Biopsy 57421
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
5543198
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$703.46 |
| Rate for Payer: Aetna Commercial |
$703.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$636.81
|
| Rate for Payer: Aetna Managed Medicare |
$102.47
|
| Rate for Payer: Anthem Medicare Advantage |
$102.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.47
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna Commercial |
$703.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.47
|
| Rate for Payer: Health EOS Commercial |
$673.84
|
| Rate for Payer: HFN Commercial |
$703.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.47
|
| Rate for Payer: Multiplan Commercial |
$592.38
|
| Rate for Payer: NAPHCARE Commercial |
$153.71
|
| Rate for Payer: Preferred Network Access Commercial |
$703.46
|
| Rate for Payer: Quartz Beloit One Network |
$325.81
|
| Rate for Payer: Quartz Commercial |
$422.07
|
| Rate for Payer: Quartz Medicare Advantage |
$102.47
|
| Rate for Payer: The Alliance Commercial |
$435.50
|
| Rate for Payer: United Healthcare Medicaid |
$147.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.47
|
| Rate for Payer: WEA Trust Commercial |
$407.26
|
| Rate for Payer: WPS Commercial |
$461.12
|
|
|
Colposcopy Of Cervix
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
1188886
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.46 |
| Max. Negotiated Rate |
$358.64 |
| Rate for Payer: Aetna Commercial |
$358.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$78.46
|
| Rate for Payer: Anthem Medicare Advantage |
$78.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.46
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$358.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$358.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$313.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$313.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$117.69
|
| Rate for Payer: Preferred Network Access Commercial |
$358.64
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$215.19
|
| Rate for Payer: Quartz Medicare Advantage |
$78.46
|
| Rate for Payer: The Alliance Commercial |
$333.44
|
| Rate for Payer: United Healthcare Medicaid |
$89.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.46
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$353.06
|
|
|
Colposcopy with Biopsy Cervix 57454
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
1188885
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.75 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Aetna Commercial |
$691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Aetna Managed Medicare |
$112.75
|
| Rate for Payer: Anthem Medicare Advantage |
$112.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.75
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$691.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.75
|
| Rate for Payer: Health EOS Commercial |
$662.48
|
| Rate for Payer: HFN Commercial |
$691.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.75
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.12
|
| Rate for Payer: Preferred Network Access Commercial |
$691.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.32
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: Quartz Medicare Advantage |
$112.75
|
| Rate for Payer: The Alliance Commercial |
$479.17
|
| Rate for Payer: United Healthcare Medicaid |
$135.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.75
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$507.36
|
|
|
Colposscopy Cervix Endocervical Curettage 57456
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
5104791
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna Commercial |
$741.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$84.03
|
| Rate for Payer: Anthem Medicare Advantage |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.03
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$741.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.03
|
| Rate for Payer: Health EOS Commercial |
$709.80
|
| Rate for Payer: HFN Commercial |
$741.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$348.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.03
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.05
|
| Rate for Payer: Preferred Network Access Commercial |
$741.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.20
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: Quartz Medicare Advantage |
$84.03
|
| Rate for Payer: The Alliance Commercial |
$357.14
|
| Rate for Payer: United Healthcare Medicaid |
$127.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.03
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$378.14
|
|
|
COLPOSUSPENSION PERIVAGINAL REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959944
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
COLPOSUSPENSION PERIVAGINAL REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959944
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$196,582.26
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$69,504.08 |
| Max. Negotiated Rate |
$196,582.26 |
| Rate for Payer: Aetna Managed Medicare |
$69,504.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196,582.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150,678.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143,154.62
|
| Rate for Payer: Anthem Medicare Advantage |
$69,504.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69,504.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69,504.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69,504.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158,914.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69,504.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69,504.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69,504.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69,504.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69,504.08
|
| Rate for Payer: NAPHCARE Commercial |
$104,256.13
|
| Rate for Payer: Quartz Medicare Advantage |
$69,504.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69,504.08
|
| Rate for Payer: Wellcare Medicare |
$69,504.08
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$125,833.51
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$44,672.38 |
| Max. Negotiated Rate |
$125,833.51 |
| Rate for Payer: Aetna Managed Medicare |
$44,672.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125,833.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96,450.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91,634.14
|
| Rate for Payer: Anthem Medicare Advantage |
$44,672.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44,672.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44,672.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44,672.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101,722.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44,672.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44,672.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44,672.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44,672.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44,672.38
|
| Rate for Payer: NAPHCARE Commercial |
$67,008.57
|
| Rate for Payer: Quartz Medicare Advantage |
$44,672.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,672.38
|
| Rate for Payer: Wellcare Medicare |
$44,672.38
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,105.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
COMBITUBE KIT 37 FR/ ADULT 4-6' 5-18537
|
Facility
|
IP
|
$746.00
|
|
| Hospital Charge Code |
2963045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.16 |
| Max. Negotiated Rate |
$713.77 |
| Rate for Payer: Aetna Commercial |
$698.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$667.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.20
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$713.77
|
| Rate for Payer: Health EOS Commercial |
$690.50
|
| Rate for Payer: HFN Commercial |
$713.77
|
| Rate for Payer: Multiplan Commercial |
$620.67
|
| Rate for Payer: Preferred Network Access Commercial |
$713.77
|
| Rate for Payer: Quartz Beloit One Network |
$380.16
|
| Rate for Payer: Quartz Commercial |
$465.50
|
| Rate for Payer: WEA Trust Commercial |
$426.71
|
| Rate for Payer: WPS Commercial |
$574.64
|
|
|
COMBITUBE KIT 37 FR/ ADULT 4-6' 5-18537
|
Facility
|
OP
|
$746.00
|
|
| Hospital Charge Code |
2963045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.24 |
| Max. Negotiated Rate |
$713.77 |
| Rate for Payer: Aetna Commercial |
$698.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$667.22
|
| Rate for Payer: Aetna Managed Medicare |
$217.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$387.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.20
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$713.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.17
|
| Rate for Payer: Health EOS Commercial |
$690.50
|
| Rate for Payer: HFN Commercial |
$713.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$581.88
|
| Rate for Payer: Multiplan Commercial |
$620.67
|
| Rate for Payer: NAPHCARE Commercial |
$465.50
|
| Rate for Payer: Preferred Network Access Commercial |
$713.77
|
| Rate for Payer: Quartz Beloit One Network |
$380.16
|
| Rate for Payer: Quartz Commercial |
$504.30
|
| Rate for Payer: Quartz Medicare Advantage |
$465.50
|
| Rate for Payer: The Alliance Commercial |
$387.92
|
| Rate for Payer: WEA Trust Commercial |
$426.71
|
| Rate for Payer: WPS Commercial |
$574.64
|
|
|
Combitube Roll-Up Kit
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
3040311
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Combitube Roll-Up Kit
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
3040311
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.92
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$71.14
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Combitube Sa Roll-Up Kit Ped
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
3040312
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Combitube Sa Roll-Up Kit Ped
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
3040312
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$58.76
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
COMBO KIT COR-KNOT MINI 031350
|
Facility
|
IP
|
$7,984.00
|
|
| Hospital Charge Code |
3072478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,068.65 |
| Max. Negotiated Rate |
$7,639.09 |
| Rate for Payer: Aetna Commercial |
$7,473.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,140.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,400.78
|
| Rate for Payer: Cash Price |
$2,395.20
|
| Rate for Payer: Cigna Commercial |
$7,639.09
|
| Rate for Payer: Health EOS Commercial |
$7,389.99
|
| Rate for Payer: HFN Commercial |
$7,639.09
|
| Rate for Payer: Multiplan Commercial |
$6,642.69
|
| Rate for Payer: Preferred Network Access Commercial |
$7,639.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,068.65
|
| Rate for Payer: Quartz Commercial |
$4,982.02
|
| Rate for Payer: WEA Trust Commercial |
$4,566.85
|
| Rate for Payer: WPS Commercial |
$6,150.08
|
|
|
COMBO KIT COR-KNOT MINI 031350
|
Facility
|
OP
|
$7,984.00
|
|
| Hospital Charge Code |
3072478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,324.94 |
| Max. Negotiated Rate |
$7,639.09 |
| Rate for Payer: Aetna Commercial |
$7,473.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,140.89
|
| Rate for Payer: Aetna Managed Medicare |
$2,324.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,151.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,985.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,400.78
|
| Rate for Payer: Cash Price |
$2,395.20
|
| Rate for Payer: Cigna Commercial |
$7,639.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,646.69
|
| Rate for Payer: Health EOS Commercial |
$7,389.99
|
| Rate for Payer: HFN Commercial |
$7,639.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,227.52
|
| Rate for Payer: Multiplan Commercial |
$6,642.69
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,639.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,068.65
|
| Rate for Payer: Quartz Commercial |
$5,397.18
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.02
|
| Rate for Payer: The Alliance Commercial |
$4,151.68
|
| Rate for Payer: WEA Trust Commercial |
$4,566.85
|
| Rate for Payer: WPS Commercial |
$6,150.08
|
|
|
COMFORT COOL THUMB (L) (LG) #2720506
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
2971141
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
COMFORT COOL THUMB (L) (LG) #2720506
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
2971141
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$128.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.08
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| Rate for Payer: Quartz Medicare Advantage |
$274.56
|
| Rate for Payer: The Alliance Commercial |
$228.80
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
COMFORT COOL THUMB (R) (LG) #92720505
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
2971139
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$128.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.08
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| Rate for Payer: Quartz Medicare Advantage |
$274.56
|
| Rate for Payer: The Alliance Commercial |
$228.80
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
COMFORT COOL THUMB (R) (LG) #92720505
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
2971139
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
COMFORT COOL THUMB (R) (MED) #55060603
|
Facility
|
IP
|
$496.00
|
|
| Hospital Charge Code |
2969840
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$252.76 |
| Max. Negotiated Rate |
$474.57 |
| Rate for Payer: Aetna Commercial |
$464.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$474.57
|
| Rate for Payer: Health EOS Commercial |
$459.10
|
| Rate for Payer: HFN Commercial |
$474.57
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: Preferred Network Access Commercial |
$474.57
|
| Rate for Payer: Quartz Beloit One Network |
$252.76
|
| Rate for Payer: Quartz Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$382.07
|
|
|
COMFORT COOL THUMB (R) (MED) #55060603
|
Facility
|
OP
|
$496.00
|
|
| Hospital Charge Code |
2969840
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$144.44 |
| Max. Negotiated Rate |
$474.57 |
| Rate for Payer: Aetna Commercial |
$464.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$474.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.67
|
| Rate for Payer: Health EOS Commercial |
$459.10
|
| Rate for Payer: HFN Commercial |
$474.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.88
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: NAPHCARE Commercial |
$309.50
|
| Rate for Payer: Preferred Network Access Commercial |
$474.57
|
| Rate for Payer: Quartz Beloit One Network |
$252.76
|
| Rate for Payer: Quartz Commercial |
$335.30
|
| Rate for Payer: Quartz Medicare Advantage |
$309.50
|
| Rate for Payer: The Alliance Commercial |
$257.92
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$382.07
|
|
|
Commercial cleansing solution - Incision, Wound Cleansing:
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
2999832
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
