|
Dilation of Female Urethra, Initial 53660
|
Professional
|
$277.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
1188977
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Medicare Advantage |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.64
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: Quartz Medicare Advantage |
$38.64
|
| Rate for Payer: The Alliance Commercial |
$164.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.64
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$173.88
|
|
|
Dilation of Female Urethra, Subsequent 53661
|
Professional
|
$288.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
1188978
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Aetna Managed Medicare |
$37.70
|
| Rate for Payer: Anthem Medicare Advantage |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.70
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.70
|
| Rate for Payer: Health EOS Commercial |
$262.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.70
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$273.60
|
| Rate for Payer: Quartz Beloit One Network |
$126.72
|
| Rate for Payer: Quartz Commercial |
$164.16
|
| Rate for Payer: Quartz Medicare Advantage |
$37.70
|
| Rate for Payer: The Alliance Commercial |
$160.22
|
| Rate for Payer: United Healthcare Medicaid |
$18.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.70
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$169.65
|
|
|
Dilation Of Lacrimal Punctum 68801
|
Professional
|
$354.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
1190820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$339.93 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Aetna Managed Medicare |
$75.54
|
| Rate for Payer: Anthem Medicare Advantage |
$75.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.54
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$336.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.54
|
| Rate for Payer: Health EOS Commercial |
$322.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.54
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$336.30
|
| Rate for Payer: Quartz Beloit One Network |
$155.76
|
| Rate for Payer: Quartz Commercial |
$201.78
|
| Rate for Payer: Quartz Medicare Advantage |
$75.54
|
| Rate for Payer: The Alliance Commercial |
$321.04
|
| Rate for Payer: United Healthcare Medicaid |
$43.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.54
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$339.93
|
|
|
Dilation of Urethral Stric Male Subsequent 53601PP
|
Professional
|
$491.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
3605561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Aetna Commercial |
$466.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$49.62
|
| Rate for Payer: Anthem Medicare Advantage |
$49.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.62
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$466.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.62
|
| Rate for Payer: Health EOS Commercial |
$446.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.62
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Preferred Network Access Commercial |
$466.45
|
| Rate for Payer: Quartz Beloit One Network |
$216.04
|
| Rate for Payer: Quartz Commercial |
$279.87
|
| Rate for Payer: Quartz Medicare Advantage |
$49.62
|
| Rate for Payer: The Alliance Commercial |
$210.88
|
| Rate for Payer: United Healthcare Medicaid |
$22.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.62
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$223.29
|
|
|
Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial 53600
|
Professional
|
$364.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
1188975
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$59.23
|
| Rate for Payer: Anthem Medicare Advantage |
$59.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.23
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.23
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.23
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$59.23
|
| Rate for Payer: The Alliance Commercial |
$251.73
|
| Rate for Payer: United Healthcare Medicaid |
$24.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.23
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$266.54
|
|
|
Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent 53601
|
Professional
|
$328.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
1188976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$49.62
|
| Rate for Payer: Anthem Medicare Advantage |
$49.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.62
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$311.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.62
|
| Rate for Payer: Health EOS Commercial |
$298.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.62
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.60
|
| Rate for Payer: Quartz Beloit One Network |
$144.32
|
| Rate for Payer: Quartz Commercial |
$186.96
|
| Rate for Payer: Quartz Medicare Advantage |
$49.62
|
| Rate for Payer: The Alliance Commercial |
$210.88
|
| Rate for Payer: United Healthcare Medicaid |
$22.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.62
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$223.29
|
|
|
DILATOR 10fr
|
Facility
IP
|
$260.00
|
|
| Hospital Charge Code |
2970839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 10fr
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
2970839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 12-18FR NOTTINGHAM 230-115
|
Facility
OP
|
$1,148.00
|
|
| Hospital Charge Code |
2964808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.44 |
| Max. Negotiated Rate |
$4,592.00 |
| Rate for Payer: Aetna Commercial |
$1,033.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.28
|
| Rate for Payer: Aetna Managed Medicare |
$321.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.44
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,056.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.42
|
| Rate for Payer: Health EOS Commercial |
$1,021.72
|
| Rate for Payer: HFN Commercial |
$1,056.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.00
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: NAPHCARE Commercial |
$688.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.16
|
| Rate for Payer: Quartz Beloit One Network |
$562.52
|
| Rate for Payer: Quartz Commercial |
$746.20
|
| Rate for Payer: Quartz Medicare Advantage |
$688.80
|
| Rate for Payer: The Alliance Commercial |
$4,592.00
|
| Rate for Payer: WEA Trust Commercial |
$631.40
|
| Rate for Payer: WPS Commercial |
$850.32
|
|
|
DILATOR 12-18FR NOTTINGHAM 230-115
|
Facility
IP
|
$1,148.00
|
|
| Hospital Charge Code |
2964808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.52 |
| Max. Negotiated Rate |
$1,056.16 |
| Rate for Payer: Aetna Commercial |
$1,033.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.44
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,056.16
|
| Rate for Payer: Health EOS Commercial |
$1,021.72
|
| Rate for Payer: HFN Commercial |
$1,056.16
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: NAPHCARE Commercial |
$688.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.16
|
| Rate for Payer: Quartz Beloit One Network |
$562.52
|
| Rate for Payer: Quartz Commercial |
$688.80
|
| Rate for Payer: WEA Trust Commercial |
$631.40
|
| Rate for Payer: WPS Commercial |
$850.32
|
|
|
DILATOR 12fr
|
Facility
IP
|
$260.00
|
|
| Hospital Charge Code |
2970840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 12fr
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
2970840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 19mm 57fr 70cm
|
Facility
OP
|
$3,171.00
|
|
| Hospital Charge Code |
2973327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$12,684.00 |
| Rate for Payer: Quartz Commercial |
$2,061.15
|
| Rate for Payer: Aetna Commercial |
$2,853.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.06
|
| Rate for Payer: Aetna Managed Medicare |
$887.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.63
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$2,917.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.49
|
| Rate for Payer: Health EOS Commercial |
$2,822.19
|
| Rate for Payer: HFN Commercial |
$2,917.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,378.25
|
| Rate for Payer: Multiplan Commercial |
$2,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,902.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,902.60
|
| Rate for Payer: The Alliance Commercial |
$12,684.00
|
| Rate for Payer: WEA Trust Commercial |
$1,744.05
|
| Rate for Payer: WPS Commercial |
$2,348.76
|
|
|
DILATOR 19mm 57fr 70cm
|
Facility
IP
|
$3,171.00
|
|
| Hospital Charge Code |
2973327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,553.79 |
| Max. Negotiated Rate |
$2,917.32 |
| Rate for Payer: Aetna Commercial |
$2,853.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.63
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$2,917.32
|
| Rate for Payer: Health EOS Commercial |
$2,822.19
|
| Rate for Payer: HFN Commercial |
$2,917.32
|
| Rate for Payer: Multiplan Commercial |
$2,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,902.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.79
|
| Rate for Payer: Quartz Commercial |
$1,902.60
|
| Rate for Payer: WEA Trust Commercial |
$1,744.05
|
| Rate for Payer: WPS Commercial |
$2,348.76
|
|
|
DILATOR 4fr MERIT
|
Facility
OP
|
$121.00
|
|
| Hospital Charge Code |
2971699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
DILATOR 4fr MERIT
|
Facility
IP
|
$121.00
|
|
| Hospital Charge Code |
2971699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
DILATOR 5fr MERIT
|
Facility
OP
|
$121.00
|
|
| Hospital Charge Code |
2971700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
DILATOR 5fr MERIT
|
Facility
IP
|
$121.00
|
|
| Hospital Charge Code |
2971700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
DILATOR 6-12FR NOTTINGHAM 230-101
|
Facility
IP
|
$1,826.00
|
|
| Hospital Charge Code |
2964809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$894.74 |
| Max. Negotiated Rate |
$1,679.92 |
| Rate for Payer: Aetna Commercial |
$1,643.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.78
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$1,625.14
|
| Rate for Payer: HFN Commercial |
$1,679.92
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,679.92
|
| Rate for Payer: Quartz Beloit One Network |
$894.74
|
| Rate for Payer: Quartz Commercial |
$1,095.60
|
| Rate for Payer: WEA Trust Commercial |
$1,004.30
|
| Rate for Payer: WPS Commercial |
$1,352.52
|
|
|
DILATOR 6-12FR NOTTINGHAM 230-101
|
Facility
OP
|
$1,826.00
|
|
| Hospital Charge Code |
2964809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.28 |
| Max. Negotiated Rate |
$7,304.00 |
| Rate for Payer: Aetna Commercial |
$1,643.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.36
|
| Rate for Payer: Aetna Managed Medicare |
$511.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,186.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$876.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.78
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.83
|
| Rate for Payer: Health EOS Commercial |
$1,625.14
|
| Rate for Payer: HFN Commercial |
$1,679.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,369.50
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,679.92
|
| Rate for Payer: Quartz Beloit One Network |
$894.74
|
| Rate for Payer: Quartz Commercial |
$1,186.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,095.60
|
| Rate for Payer: The Alliance Commercial |
$7,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,004.30
|
| Rate for Payer: WPS Commercial |
$1,352.52
|
|
|
DILATOR 6FR
|
Facility
OP
|
$163.00
|
|
| Hospital Charge Code |
2970585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
DILATOR 6FR
|
Facility
IP
|
$163.00
|
|
| Hospital Charge Code |
2970585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
DILATOR 6fr MERIT
|
Facility
OP
|
$121.00
|
|
| Hospital Charge Code |
2971701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
DILATOR 6fr MERIT
|
Facility
IP
|
$121.00
|
|
| Hospital Charge Code |
2971701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
DILATOR 7FR
|
Facility
IP
|
$260.00
|
|
| Hospital Charge Code |
2970842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
