|
Drain/Inject,Joint/Bursa 2061022
|
Professional
|
$264.00
|
|
|
Service Code
|
CPT 20610 22
|
| Hospital Charge Code |
4746606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.16 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$250.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.40
|
| Rate for Payer: Health EOS Commercial |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.80
|
| Rate for Payer: Quartz Beloit One Network |
$116.16
|
| Rate for Payer: Quartz Commercial |
$150.48
|
| Rate for Payer: The Alliance Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
Drain/Inject,Joint/Bursa 2061050
|
Professional
|
$440.00
|
|
|
Service Code
|
CPT 20610 50
|
| Hospital Charge Code |
3157515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: Aetna Commercial |
$418.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$418.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$220.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.00
|
| Rate for Payer: Health EOS Commercial |
$400.40
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Preferred Network Access Commercial |
$418.00
|
| Rate for Payer: Quartz Beloit One Network |
$193.60
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
DRAIN IRRIGATION 3 7724
|
Facility
IP
|
$48.00
|
|
| Hospital Charge Code |
2964067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
DRAIN IRRIGATION 3 7724
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
2964067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
DRAIN LOWER LEG LESION 27603
|
Professional
|
$1,595.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
3014110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.26 |
| Max. Negotiated Rate |
$1,650.92 |
| Rate for Payer: Aetna Commercial |
$1,515.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,371.70
|
| Rate for Payer: Aetna Managed Medicare |
$366.87
|
| Rate for Payer: Anthem Medicare Advantage |
$366.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$366.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$366.87
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$1,515.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$797.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.87
|
| Rate for Payer: Health EOS Commercial |
$1,451.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$366.87
|
| Rate for Payer: Multiplan Commercial |
$1,276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.25
|
| Rate for Payer: Quartz Beloit One Network |
$701.80
|
| Rate for Payer: Quartz Commercial |
$909.15
|
| Rate for Payer: Quartz Medicare Advantage |
$366.87
|
| Rate for Payer: The Alliance Commercial |
$1,559.20
|
| Rate for Payer: United Healthcare Medicaid |
$196.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.87
|
| Rate for Payer: WEA Trust Commercial |
$877.25
|
| Rate for Payer: WPS Commercial |
$1,650.92
|
|
|
Drain Lower Leg Lesion 2760350
|
Professional
|
$3,190.00
|
|
|
Service Code
|
CPT 27603 50
|
| Hospital Charge Code |
5360723
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,403.60 |
| Max. Negotiated Rate |
$3,030.50 |
| Rate for Payer: Aetna Commercial |
$3,030.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,743.40
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$3,030.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,595.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,914.00
|
| Rate for Payer: Health EOS Commercial |
$2,902.90
|
| Rate for Payer: Multiplan Commercial |
$2,552.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,403.60
|
| Rate for Payer: Quartz Commercial |
$1,818.30
|
| Rate for Payer: The Alliance Commercial |
$1,595.00
|
| Rate for Payer: WEA Trust Commercial |
$1,754.50
|
| Rate for Payer: WPS Commercial |
$2,362.83
|
|
|
DRAIN NECK/CHEST LESION 21501
|
Professional
|
$1,336.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
3013735
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.03 |
| Max. Negotiated Rate |
$1,415.43 |
| Rate for Payer: Aetna Commercial |
$1,269.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,148.96
|
| Rate for Payer: Aetna Managed Medicare |
$314.54
|
| Rate for Payer: Anthem Medicare Advantage |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$314.54
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,269.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$668.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.54
|
| Rate for Payer: Health EOS Commercial |
$1,215.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,089.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$314.54
|
| Rate for Payer: Multiplan Commercial |
$1,068.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.20
|
| Rate for Payer: Quartz Beloit One Network |
$587.84
|
| Rate for Payer: Quartz Commercial |
$761.52
|
| Rate for Payer: Quartz Medicare Advantage |
$314.54
|
| Rate for Payer: The Alliance Commercial |
$1,336.80
|
| Rate for Payer: United Healthcare Medicaid |
$174.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.54
|
| Rate for Payer: WEA Trust Commercial |
$734.80
|
| Rate for Payer: WPS Commercial |
$1,415.43
|
|
|
DRAIN PELVIC ABSCESS, PERCUT 58823
|
Professional
|
$4,796.00
|
|
| Hospital Charge Code |
3015142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,110.24 |
| Max. Negotiated Rate |
$4,556.20 |
| Rate for Payer: Aetna Commercial |
$4,556.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,124.56
|
| Rate for Payer: Cash Price |
$1,438.80
|
| Rate for Payer: Cigna Commercial |
$4,556.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,398.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,877.60
|
| Rate for Payer: Health EOS Commercial |
$4,364.36
|
| Rate for Payer: Multiplan Commercial |
$3,836.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.24
|
| Rate for Payer: Quartz Commercial |
$2,733.72
|
| Rate for Payer: The Alliance Commercial |
$2,398.00
|
| Rate for Payer: WEA Trust Commercial |
$2,637.80
|
| Rate for Payer: WPS Commercial |
$3,552.40
|
|
|
DRAIN PENROSE 1/2 X 18 DYND50428/DYND50422"
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
2963783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
DRAIN PENROSE 1/2 X 18 DYND50428/DYND50422"
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
2963783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$5.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
DRAIN PENROSE 1/4x 18 DYND50427"
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
2963366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$5.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
DRAIN PENROSE 1/4x 18 DYND50427"
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
2963366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
DRAIN PENROSE 1 IN.X 36 IN.
|
Facility
IP
|
$3.00
|
|
| Hospital Charge Code |
2963880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
DRAIN PENROSE 1 IN.X 36 IN.
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
2963880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
DRAIN ROUND SUCTION 1/8 (10FR) 0070310"
|
Facility
OP
|
$231.00
|
|
| Hospital Charge Code |
2963354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$64.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.25
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$138.60
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
DRAIN ROUND SUCTION 1/8 (10FR) 0070310"
|
Facility
IP
|
$231.00
|
|
| Hospital Charge Code |
2963354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
DRAIN SHOULDER LESION 23030
|
Professional
|
$1,517.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
3013757
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.28 |
| Max. Negotiated Rate |
$1,441.15 |
| Rate for Payer: Aetna Commercial |
$1,441.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.62
|
| Rate for Payer: Aetna Managed Medicare |
$237.28
|
| Rate for Payer: Anthem Medicare Advantage |
$237.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$237.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$237.28
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,441.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$758.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.28
|
| Rate for Payer: Health EOS Commercial |
$1,380.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$840.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$237.28
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,441.15
|
| Rate for Payer: Quartz Beloit One Network |
$667.48
|
| Rate for Payer: Quartz Commercial |
$864.69
|
| Rate for Payer: Quartz Medicare Advantage |
$237.28
|
| Rate for Payer: The Alliance Commercial |
$1,008.44
|
| Rate for Payer: United Healthcare Medicaid |
$249.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.28
|
| Rate for Payer: WEA Trust Commercial |
$834.35
|
| Rate for Payer: WPS Commercial |
$1,067.76
|
|
|
DRAIN THIGH/KNEE LESION 27301
|
Professional
|
$1,866.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
3014043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.26 |
| Max. Negotiated Rate |
$2,133.36 |
| Rate for Payer: Aetna Commercial |
$1,772.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,604.76
|
| Rate for Payer: Aetna Managed Medicare |
$474.08
|
| Rate for Payer: Anthem Medicare Advantage |
$474.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$474.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$474.08
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$1,772.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$933.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$474.08
|
| Rate for Payer: Health EOS Commercial |
$1,698.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,672.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,672.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$474.08
|
| Rate for Payer: Multiplan Commercial |
$1,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.70
|
| Rate for Payer: Quartz Beloit One Network |
$821.04
|
| Rate for Payer: Quartz Commercial |
$1,063.62
|
| Rate for Payer: Quartz Medicare Advantage |
$474.08
|
| Rate for Payer: The Alliance Commercial |
$2,014.84
|
| Rate for Payer: United Healthcare Medicaid |
$196.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.08
|
| Rate for Payer: WEA Trust Commercial |
$1,026.30
|
| Rate for Payer: WPS Commercial |
$2,133.36
|
|
|
DRAIN WOUND TUBING 1/4 0070330"
|
Facility
IP
|
$378.00
|
|
| Hospital Charge Code |
2963353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.22 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.34
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$347.76
|
| Rate for Payer: Health EOS Commercial |
$336.42
|
| Rate for Payer: HFN Commercial |
$347.76
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: NAPHCARE Commercial |
$226.80
|
| Rate for Payer: Preferred Network Access Commercial |
$347.76
|
| Rate for Payer: Quartz Beloit One Network |
$185.22
|
| Rate for Payer: Quartz Commercial |
$226.80
|
| Rate for Payer: WEA Trust Commercial |
$207.90
|
| Rate for Payer: WPS Commercial |
$279.98
|
|
|
DRAIN WOUND TUBING 1/4 0070330"
|
Facility
OP
|
$378.00
|
|
| Hospital Charge Code |
2963353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$340.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.08
|
| Rate for Payer: Aetna Managed Medicare |
$105.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.34
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$347.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.53
|
| Rate for Payer: Health EOS Commercial |
$336.42
|
| Rate for Payer: HFN Commercial |
$347.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: NAPHCARE Commercial |
$226.80
|
| Rate for Payer: Preferred Network Access Commercial |
$347.76
|
| Rate for Payer: Quartz Beloit One Network |
$185.22
|
| Rate for Payer: Quartz Commercial |
$245.70
|
| Rate for Payer: Quartz Medicare Advantage |
$226.80
|
| Rate for Payer: The Alliance Commercial |
$1,512.00
|
| Rate for Payer: WEA Trust Commercial |
$207.90
|
| Rate for Payer: WPS Commercial |
$279.98
|
|
|
DRAIN WOUND TUBING FLAT 10mm 0070440
|
Facility
OP
|
$182.00
|
|
| Hospital Charge Code |
2963515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
DRAIN WOUND TUBING FLAT 10mm 0070440
|
Facility
IP
|
$182.00
|
|
| Hospital Charge Code |
2963515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
DRAPE ALCON APERTURE 8065153120
|
Facility
IP
|
$382.00
|
|
| Hospital Charge Code |
5264687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$351.44 |
| Rate for Payer: Aetna Commercial |
$343.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.46
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$351.44
|
| Rate for Payer: Health EOS Commercial |
$339.98
|
| Rate for Payer: HFN Commercial |
$351.44
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: NAPHCARE Commercial |
$229.20
|
| Rate for Payer: Preferred Network Access Commercial |
$351.44
|
| Rate for Payer: Quartz Beloit One Network |
$187.18
|
| Rate for Payer: Quartz Commercial |
$229.20
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
DRAPE ALCON APERTURE 8065153120
|
Facility
OP
|
$382.00
|
|
| Hospital Charge Code |
5264687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.96 |
| Max. Negotiated Rate |
$1,528.00 |
| Rate for Payer: Aetna Commercial |
$343.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Aetna Managed Medicare |
$106.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.46
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$351.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.77
|
| Rate for Payer: Health EOS Commercial |
$339.98
|
| Rate for Payer: HFN Commercial |
$351.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.50
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: NAPHCARE Commercial |
$229.20
|
| Rate for Payer: Preferred Network Access Commercial |
$351.44
|
| Rate for Payer: Quartz Beloit One Network |
$187.18
|
| Rate for Payer: Quartz Commercial |
$248.30
|
| Rate for Payer: Quartz Medicare Advantage |
$229.20
|
| Rate for Payer: The Alliance Commercial |
$1,528.00
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
DRAPE ARTHOSCOPY ORTHOARTS 89267
|
Facility
OP
|
$777.00
|
|
| Hospital Charge Code |
2963022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Aetna Managed Medicare |
$217.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.81
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.75
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$466.20
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$505.05
|
| Rate for Payer: Quartz Medicare Advantage |
$466.20
|
| Rate for Payer: The Alliance Commercial |
$3,108.00
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
